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September/October 2026 Top of Mind
Clarification on Medicaid prior auth requirements for ABA and other outpatient services
When Optum Behavioral Health/UnitedHealthcare Community Plan of Indiana is the secondary payer, Indiana providers of outpatient Applied Behavioral Analysis (ABA) services to Medicaid members have one less administrative task to worry about – submitting prior authorization requests.
That’s right. Optum does not require you submit a prior authorization when we are the secondary payer for outpatient services delivered to Medicaid members – including ABA services. Prior authorization is only required when we are the primary payer for ABA services to Medicaid members.
The guidance below can help you avoid unnecessary work, delays and claim denials related to submitting prior authorizations and claims.
Questions? We’re here to help.
For questions, please call Provider Services at 1-877-610-9785, 8 am – 8 pm ET, Monday – Friday.
Confirm if patients have secondary insurance |
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Submitting secondary insurance claims |
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Include the primary claim number |
Note this under the Original Reference Number |
Attach the original Provider Remittance Advice (PRA) / Explanation of Benefits (EOB) |
Attach the original claim PRA/EOB for the member’s primary insurance, so we can process the secondary claim accurately |
Enter the amount paid |
Enter the amount paid by the primary insurance or other payer in Box 29 of the CMS-1500 form |
