Alliance Health (NC LME-MCO)

MedicaidNC

ABA billing requirements · Source: Alliance Health LME-MCO — Provider Resources

High confidence

Verified 2026-03-01

Authorization Requirements

Requires prior auth Yes

Initial auth duration6 months

Renewal auth duration6 months

Submission deadline14 days

Unit tracking cadenceTotal

Requires FBA Yes

Diagnostic eval validity36 months

Re-eval cadenceEvery 6 months

State licensure requiredBCBA state licensure required via NC Psychology Board

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsASD diagnosis, Functional Behavior Assessment, Baseline data, Person-centered goals, Intervention strategies, Crisis plan, Discharge criteria

Progress summary cadenceEvery 6 months

Policy Notes

Alliance Health is the LME-MCO serving Durham, Wake, Cumberland, and Johnston counties in NC. ABA services require prior auth through Alliance. NC Medicaid transitioned to Tailored Plans in 2023 — Alliance manages behavioral health for its region. BCBA must be enrolled with Alliance.

CPT & Modifier Rules

CPT rules require a free account

View H-codes, modifiers, unit limits, and billing restrictions for Alliance Health (NC LME-MCO).

Official policy source:Alliance Health LME-MCO — Provider Resources

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Data last verified: 2026-03-01 · Confidence: High · See our methodology

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