Every payer rule, pre-loaded.
Every major payer pre-configured for your state. CPT limits, required documents, submission formats, diagnosis codes — all current, all enforced automatically. New Jersey live today; Maryland in active development.
- 6
- NJ payers live
- 59
- Enforced rules
- 0
- Manual payer lookups
Horizon BCBS NJ
Submission
Phone
Initial
6 months
Re-Auth
6 months
- Caregiver plan required
- Discharge & fading plan
- Standardized assessment (2+ tools)
- BCBA billing required
Horizon NJ Health
Submission
Phone
Initial
6 months
Re-Auth
6 months
No fax — phone submission only
- 799.0–799.9 accepted
- BCBA supervision required
- Daily visit caps enforced
Aetna NJ
Submission
Fax
Initial
3 months
Re-Auth
6 months
3-month initial auth (shorter than most)
- Fax PA packet PDF
- Assessment within 12mo
- BCBA billing required
AmeriHealth NJ
Submission
Fax
Initial
6 months
Re-Auth
6 months
- Diagnosis enforcement
- BCBA billing required
UHC Community Plan NJ
Submission
Phone
Initial
6 months
Re-Auth
6 months
- Managed Medicaid plan
- Standard CPT coverage
NJ Medicaid FFS
Submission
Portal
Initial
No PA (initial)
Re-Auth
PA required
No PA required for initial — re-auth only
- ASD diagnosis from a qualified provider required
- Covers through age 21
- Fee-for-service plan
Maryland — coming soon
Carelon BHASO and CareFirst BCBS MD payer rules are built. Launching to early-access practices soon.
Every payer rule, enforced before submission.
Red “hard stop” badges block submissions that would be rejected. Your team only sees what passes the rules.
Payer requirements configuration — Horizon BCBS NJ
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