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New York Medicaid ABA Program
The process for requesting ABA services has gone digital
Effective November 18, 2024, the process for requesting ABA services has changed. Our new digital process saves time and is part of our commitment to making working with us easier.
Learn the new steps on your time
What to have ready for your ABA request
Provider data: Name, address, NPI and TIN
Member data: Name, address and Member ID*
*Member ID search is a feature in the digital request.
Submit a digital ABA services request
Log in to the Provider Express secure portal
Select 'Auths' from the upper right menu
Click the 'Auth request' tab
Choose 'Request a new authorization'
Select ABA Assessment from the drop down menu
Complete the required fields and submit
Other ABA authorization submissions can be started here.
Other ABA treatment submissions can be started here.
Note: Effective 2/1/2024, services with a place of services school (03) including preschools are not covered.
UnitedHealthcare Community Plan is one of the selected managed care plans providing coverage to New York Child Health Plus (CHP)and New York Essential Plan Plus (EPP) members. Optum has been selected by UnitedHealthcare Community Plan to develop and manage the ABA network for New York CHP and EPP members. Your participation in our network helps to ensure access to comprehensive quality care for covered behavioral health services for enrolled members.
Effective April 4, 2023, New York State Department of Health (NYSDOH) added the following two CPT codes for ABA service for New York Medicaid Managed Care children under 21:
- CPT code 97154
- CPT code 97157
For more, please see the April 2023 NYSDOH bulletin detailing these additional codes: New York State Medicaid Update - March 2023 Volume 39 - Number 6
Effective January 1, 2023, UnitedHealthcare Community Plan is one of the selected managed care plans providing coverage to New York Medicaid members. Optum has been selected by UnitedHealthcare Community Plan to develop and manage the ABA network for New York Medicaid members.
To assist you in your participation in this program, learn more about the process for applying to the network, and the clinical protocols required in this unique network, please review the resource materials below.
- New York CHP and EPP ABA Provider Orientation
- New York CHP ABA and EPP Provider Quick Reference Guide
- New York ABA Medicaid Provider Orientation
- New York ABA Medicaid Quick Reference Guide
Contact Us/Request to Join the Network
Jaime Schweers
Specialty Network Manager
Jaime_schweers@optum.com
