Priority Partners and ABA Prior Authorization: A Maryland Parent’s Guide

Priority Partners is one of the larger Medicaid managed care plans in Maryland, and a lot of Baltimore families have it. When ABA comes up, the questions almost always land on the same step: prior authorization.

Here's what parents ask most, answered as directly as possible.

What is prior authorization?

It's approval from the payer before services start. For ABA, the provider sends a treatment plan showing what your child needs and how many hours are recommended. Once it's approved, sessions can begin for the number of hours and the time period on the approval.

The approval usually lists a start date, an end date and a number of hours or units. Read all three.

No approval, no billed sessions. That's why this step matters so much.

Does Priority Partners approve ABA itself?

Usually not. Priority Partners is a HealthChoice managed care organization, but in Maryland Medicaid, ABA runs through the state's public behavioral health system, which has its own administrator. Since January 2025, that's been Carelon Behavioral Health.

Your ABA provider handles the submission. Still, knowing who actually reviews it saves you from calling the wrong number and getting a confusing answer.

What does the provider need from me?

Typically:

• Your child's Medicaid ID

• The diagnosis report from a qualified clinician

• Any referral or recommendation for ABA, if the evaluation includes one

• Time for an initial assessment

Ask whether your child's evaluation needs to say ABA is recommended. Some families find that a brief note from the diagnosing clinician speeds things along.

How long does it take?

It varies. Some approvals come back in days, others take weeks, especially if the reviewer asks for more information. The bigger wait is often before the authorization step, for the assessment itself.

Ask your provider for a realistic timeline when you sign up, and ask them to tell you when the plan is submitted. That way you're not guessing. It's also fair to ask whether there's a cancellation list for assessments. Some families get in weeks earlier that way.

What if my child is under 3?

You don't have to wait around. Maryland's early intervention system serves babies and toddlers through the Maryland Infants and Toddlers Program, and an Individualized Family Service Plan is developed within 45 days of referral. It runs on a separate track from Medicaid ABA, and families can pursue both at once.

How many hours will be approved?

That depends on your child's needs and what the treatment plan supports with data. A preschooler with intensive needs may be recommended more hours than a school-age child with more targeted goals. The approval might also come back lower than what was requested.

If the approved hours seem too low, ask your BCBA why, and whether a revised plan or more documentation would help.

What happens when the authorization runs out?

Authorizations have end dates, often every six months. Before that, the BCBA updates the treatment plan with progress data and submits it again. Keep each approval letter and mark the end date on your calendar a month ahead.

What if it's denied?

Ask for the denial in writing, with the reason. Share it with your BCBA. Medicaid members have appeal rights, and the letter should spell out the steps and deadlines. Those deadlines can be short, so don't let plan mail sit unopened.

Where do I start?

Find your child's diagnosis report and Medicaid card and put them in one place. Then call a provider that works with Priority Partners and ask how their intake works. Keep a notebook by the phone for every call: the date, who you spoke with and what you were told.

For families in Baltimore, visit Able Minds ABA to see how their in-home ABA program is set up and what the first steps look like.

Able Minds Aba offers in-home, school-based, and telehealth Aba therapy for children with autism in Maryland, Virginia, and the Baltimore area. Bcba-led programs build communication, daily living, and social skills, with insurance handled for you.