Foundations · Stage 1 · DreamPrintable checklistTexas

First-payer decision worksheet

Before any application clock starts, put the three payer lanes side by side. Fill in what each one asks of you, what you still need to look up, and then write down a decision you can defend.

Checked November 2, 2026 · Billing4ABA · Billing built only for ABA.

Read the hint in each box, then write your own answer underneath. Anything marked "look up" changes by plan, so call or check the plan's provider manual and note the date you checked.

Side by side

Question	Texas Medicaid (TMHP + managed care plans)	Commercial plans	TRICARE (West region, TriWest)
Who can enroll?	Only a Licensed Behavior Analyst (LBA) enrolls for ABA. The LBA's individual NPI is both the rendering and the billing provider. Groups do not enroll.	Ask each plan: do you contract with the group, the individual BCBA, or both? Are RBTs credentialed, or only supervised?	Ask TriWest which provider types it accepts under the Autism Care Demonstration (ACD) and how supervisors and technicians are listed.
What must exist first?	A current TDLR license that does not expire within 30 days of applying. Enrollment runs through TMHP's PEMS and includes a site visit.	Usually your entity, EIN, NPIs, a complete CAQH profile, license and liability insurance. Confirm each plan's own list.	Look up TriWest's current requirements. ACD providers complete ACD provider education each calendar year, by December 31.
Who is covered?	ABA for dates of service on or after Feb 1, 2022, under THSteps-CCP: members age 20 and under with an autism diagnosis from a comprehensive evaluation, made or reconfirmed within 3 years.	The Texas mandate (§1355.015) applies to fully insured group plans when the diagnosis was made before the child's 10th birthday. Self-funded employer plans and individual plans can differ: ask which kind the family has.	Military families. Texas moved to the TRICARE West region on Jan 1, 2025, and TriWest is the West contractor.
How does authorization work?	Prior authorization is required for all ABA services. After TMHP enrollment you contract and credential with each managed care plan (MCO), and each MCO runs its own prior authorization.	Varies by plan and by who administers the ABA benefit. Write down each plan's process, forms and turnaround.	Look up how TriWest handles ACD authorizations and renewals today.
Filing limit to look up	Fee-for-service: 95 days from the date of service; appeals within 120 days. MCOs set their own limits: check each plan's manual.	Each contract sets its own. Find it in the contract or provider manual before claim one.	Look up TriWest's current filing limit and write it here.
Which plans serve your area?	Circle your service area in the STAR Kids list below. STAR Health is Superior statewide.	List the plans the families on your waitlist actually carry.	Ask your referral sources how many military families they see.
Your decision	Start now · Start later · Not for us. Why:	Start now · Start later · Not for us. Why:	Start now · Start later · Not for us. Why:

Texas Medicaid (TMHP + managed care plans)

Who can enroll?: Only a Licensed Behavior Analyst (LBA) enrolls for ABA. The LBA's individual NPI is both the rendering and the billing provider. Groups do not enroll.
What must exist first?: A current TDLR license that does not expire within 30 days of applying. Enrollment runs through TMHP's PEMS and includes a site visit.
Who is covered?: ABA for dates of service on or after Feb 1, 2022, under THSteps-CCP: members age 20 and under with an autism diagnosis from a comprehensive evaluation, made or reconfirmed within 3 years.
How does authorization work?: Prior authorization is required for all ABA services. After TMHP enrollment you contract and credential with each managed care plan (MCO), and each MCO runs its own prior authorization.
Filing limit to look up: Fee-for-service: 95 days from the date of service; appeals within 120 days. MCOs set their own limits: check each plan's manual.
Which plans serve your area?: Circle your service area in the STAR Kids list below. STAR Health is Superior statewide.
Your decision: Start now · Start later · Not for us. Why:

Commercial plans

Who can enroll?: Ask each plan: do you contract with the group, the individual BCBA, or both? Are RBTs credentialed, or only supervised?
What must exist first?: Usually your entity, EIN, NPIs, a complete CAQH profile, license and liability insurance. Confirm each plan's own list.
Who is covered?: The Texas mandate (§1355.015) applies to fully insured group plans when the diagnosis was made before the child's 10th birthday. Self-funded employer plans and individual plans can differ: ask which kind the family has.
How does authorization work?: Varies by plan and by who administers the ABA benefit. Write down each plan's process, forms and turnaround.
Filing limit to look up: Each contract sets its own. Find it in the contract or provider manual before claim one.
Which plans serve your area?: List the plans the families on your waitlist actually carry.
Your decision: Start now · Start later · Not for us. Why:

TRICARE (West region, TriWest)

Who can enroll?: Ask TriWest which provider types it accepts under the Autism Care Demonstration (ACD) and how supervisors and technicians are listed.
What must exist first?: Look up TriWest's current requirements. ACD providers complete ACD provider education each calendar year, by December 31.
Who is covered?: Military families. Texas moved to the TRICARE West region on Jan 1, 2025, and TriWest is the West contractor.
How does authorization work?: Look up how TriWest handles ACD authorizations and renewals today.
Filing limit to look up: Look up TriWest's current filing limit and write it here.
Which plans serve your area?: Ask your referral sources how many military families they see.
Your decision: Start now · Start later · Not for us. Why:

Texas Medicaid STAR Kids plans by service area

From the HHSC service area map (January 2026). Tick your area. Wellpoint is the former Amerigroup.

Bexar: Superior, Community First
Dallas: Aetna, Wellpoint
El Paso: Superior, Wellpoint
Harris: Texas Children's, United, Wellpoint
Hidalgo: Driscoll, Superior, United
Jefferson: Texas Children's, United
Lubbock: Superior, Wellpoint
MRSA Central: BCBSTX, United
MRSA Northeast: Texas Children's, United
MRSA West: Superior, Wellpoint
Nueces: Driscoll, Superior
Tarrant: Aetna, Cook Children's
Travis: BCBSTX, Superior
STAR Health: Superior, statewideCheck the current map before you contact a plan; service areas and plans can change.

Before you decide

Count the families already asking for you, by payer.Your waitlist is better evidence than a guess about the market.
Name the person who will follow up on each application every week, and when.
Check your license dates leave room for the application.Texas Medicaid: the TDLR license must not expire within 30 days of applying.
Pick one lane to start first and one to start next. Write the start date for each.
Plan cash for the months before the first payment arrives.

Sources

[1]TMPPM Children's Services Handbook, §2.3 (TMHP) https://www.tmhp.com/sites/default/files/microsites/provider-manuals/tmppm/html/TMPPM/2_04_Childrens_Services/2_04_Childrens_Services.htm
[2]TMHP: Licensed behavior analyst enrollment (PDF) https://www.tmhp.com/sites/default/files/file-library/medicaid/Licensed-behavior-analyst-enrollment.pdf
[3]1 TAC §354.5011 https://law.cornell.edu/regulations/texas/1-Tex-Admin-Code-SS-354-5011
[4]CASP / txABA webinar on Texas Medicaid ABA (2022). Check each plan's current instructions.
[5]1 TAC §354.1003 (timely filing) https://law.cornell.edu/regulations/texas/1-Tex-Admin-Code-SS-354-1003
[6]HHSC Medicaid managed care service areas map (Jan 2026) https://fhb.hhs.texas.gov/sites/default/files/documents/services/health/medicaid-chip/programs/managed-care-service-areas-map.pdf
[7]Tex. Ins. Code §1355.015 https://texas.public.law/statutes/tex._ins._code_section_1355.015
[8]TRICARE contract transition FAQ https://tricare.mil/About/Changes/Contract-Transition-Frequently-Asked-Questions
[9]TriWest: Autism Care Demonstration for providers https://tricare.triwest.com/en/provider/autism-care-demonstration/

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