Applied Behavioral Analysis Application and Coding Information for Providers

Pursuant to Oklahoma Administrative Code 317:30-3-65.12, effective July 1, 2019, all Board Certified Behavior Analysts (BCBAs) interested in providing compensable services to SoonerCare members ages 21 and younger are required to apply and be approved for a provider contract with the Oklahoma Healthcare Authority (OHCA).

Individuals will apply by accessing OHCA’s provider portal, selecting “Applied Behavior Analyst” as the provider type and then selecting either Board Certified Behavior Analyst (BCBA) or Board Certified Assistant Behavior Analyst (BCaBA) as the specialty.

In order to complete your application, you will be required to upload a copy of your national certification (licensed human services professionals), license or certificate issued by DHS on behalf of the Oklahoma Licensed Behavior Analyst Board (BCBAs, BCaBAs and unlicensed human services professionals) and/or human services professional license (licensed human services professionals), if applicable. Please note, if you are currently contracted with OHCA to provide other compensable services to SoonerCare members, you will be required to have a separate contract for ABA services. To begin enrollment, please access the following link: https://www.ohcaprovider.com/Enrollment/(S(dpch43qo4ndvkoprsvpysme2))/Site/Home/createuser.aspx. If you have any questions regarding contracting, please call 1-800-522-0114 option 5 or email ProviderEnrollment@okhca.org to receive assistance.

Once you have been approved for a provider contract and issued an OHCA rendering provider identification number, you may begin submitting requests for prior authorization (PA) of medically necessary ABA services for SoonerCare members. The PA form must be typed and not handwritten. You must have the 2019 version of Adobe Pro and make sure that pop up blockers are turned off to access the form. Submission of a PA request form is not a guarantee of payment.

The ABA PA templates can be found under forms at: http://www.okhca.org/providers.aspx?id=588&menu=74&parts=7581_7583. Please complete every section of the form and fax the form, along with the supportive documentation requested, to 405-530-7260. If you have any questions regarding the ABA PA template, please contact Tanesha Hooks at 405-522-7597.

The CPT codes 97151,97155 and 97156 will be utilized for reimbursement once the provider has a contract with OHCA. The CPT code 97153 for Registered Behavior Technician (RBT) is not yet a reimbursable code by OHCA. However, once DHS includes RBT as a specialty type in its rules, OHCA will begin the process of including the RBT provider type in its rules and its federally-approved State Plan, so that the RBT can be a contracted provider type with OHCA.

BCaBAs must be employed by a SoonerCare-contracted group or agency when billing ABA services. Payment for ABA services rendered by a BCaBA or any other supervised practitioner may only be made to his or her supervisor, or the employing agency or corporate entity.

Approval of the State Plan Amendment through CMS is still in progress and has a targeted effective date of July 1, 2019, once approved. Please note that claims sent in by a BCBA, OHCA-contracted provider will deny on all edits until CMS approval is effective. However, once CMS approval is obtained, all denied claims will be recycled to ensure payment of prior authorized medically necessary services that were rendered.