ABA Insight tracks authorization rules, documentation requirements, and CPT modifier policies across 192 payors.This page explains exactly how we collect, verify, and maintain that data — and what our accuracy guarantee means.
Official payor policy documents, provider manuals, and Medicaid bulletins — not secondhand aggregators. We link to the source on every record.
Top commercial + high-volume Medicaid payors: monthly. All other payors: quarterly. Every record shows its last-verified date.
Verified = confirmed in the last review cycle. Likely Current = no known changes, but past the review window. Needs Review = flag it and verify before submitting.
If you find an error in our payor data — a wrong modifier requirement, an incorrect authorization duration, an outdated policy URL — we will refund your last month's subscription. No questions asked.
To report an error, email [email protected] with the payor name, the field in question, and the correct value with a link to the source document. We will review and correct within 2 business days.
Clinical policy bulletins, provider manuals, and coverage determination guidelines published directly by payors on their provider portals.
State Medicaid agency provider handbooks, billing guidelines, and administrative codes (e.g., AHCA, TMHP, eMedNY, DMAS).
CMS guidance, TRICARE Autism Care Demonstration program documents, and CHAMPVA benefit coverage guidelines.
Provider news bulletins, listserv announcements, and regulatory filings tracked via payor provider portals and industry publications.
For each payor, we identify the authoritative source document — the clinical policy bulletin, provider manual, or state Medicaid handbook that governs ABA coverage. We link directly to this document on each payor record.
We extract specific data points (authorization duration, unit tracking cadence, submission deadline, FBA requirement, modifier rules) from the source document. Each field is mapped to the specific section or page of the source document.
For commercial payors, we cross-reference the policy document against the payor's provider portal authorization requirements and any recent provider news bulletins to identify discrepancies.
Each record receives a confidence tier based on source quality and recency: Verified (direct policy document, current year), Likely Current (policy document, prior year or indirect source), or Needs Review (limited source documentation or known policy ambiguity).
All records are reviewed on a quarterly basis. High-priority payors (Aetna, Anthem, Cigna, UHC, Humana, and the top 10 state Medicaid programs by ABA enrollment) are reviewed monthly.
Data extracted directly from the payor's current clinical policy bulletin, provider manual, or state Medicaid handbook. Source document is dated within the current or prior calendar year. Policy URL links directly to the source.
Data extracted from a policy document that may be 1–2 years old, or from an indirect source (e.g., provider news bulletin rather than the full policy document). The policy is likely still accurate but has not been verified against the most current source document.
Limited source documentation available, known policy ambiguity, or a policy that is under active revision. Use this data as a starting point only and verify directly with the payor before submitting claims.
Not all payors are reviewed on the same schedule. High-volume payors with frequent policy changes receive monthly attention; smaller or more stable payors are reviewed quarterly. The table below shows the exact cadence per tier, along with the specific trigger events that can prompt an out-of-cycle update.
| Payor Tier | Payors | Cadence | Out-of-Cycle Triggers |
|---|---|---|---|
| Tier 1 — National Commercial | Aetna, Anthem, Cigna, UHC, Humana | Monthly | Policy bulletin, provider news, provider portal change |
| Tier 2 — Regional Commercial | BCBS affiliates, Molina, Centene, Magellan, others | Quarterly | Annual policy review, provider news alerts |
| Tier 3 — Top 10 State Medicaid | CA, TX, FL, NY, PA, OH, IL, GA, NC, MI Medicaid | Monthly | State regulatory filings, Medicaid agency bulletins |
| Tier 4 — Remaining State Medicaid | All other state Medicaid programs (41 states) | Quarterly | Legislative changes, state agency announcements |
| Tier 5 — Government | TRICARE, CHAMPVA | Quarterly | Federal regulatory updates, CMS guidance |
All payors are also monitored continuously for out-of-cycle changes via provider portal alerts and industry publications. When a change is detected, it is reviewed and published within 5 business days regardless of the scheduled review cycle.
ABA Insight tracks payor-level policies. Individual plan-level variations (e.g., employer-sponsored plans with custom benefit designs) may differ from the payor's standard policy.
Medicaid managed care organizations (MCOs) within a state may have policies that differ from the fee-for-service Medicaid policy. We note MCO-specific variations where known but cannot guarantee completeness.
Policy changes can occur between our review cycles. Always verify authorization requirements directly with the payor before submitting a request for a new patient or a renewal.
ABA Insight is a reference tool, not a substitute for direct payor communication. We do not provide legal or billing compliance advice.
ABA Insight's data team includes certified professional coders (CPCs) with ABA billing specialization, former ABA billing directors, and healthcare policy researchers. All data updates are reviewed by at least one team member with direct ABA billing experience before publication.
We also accept corrections and updates from our user community. If you have access to a payor policy document that we have not yet incorporated, please email [email protected].
192 payors, verified data, and a team that stands behind every record.
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