This two-page guide (PDF) provides information you need to successfully submit claims, get paid quickly, request authorization, and find important phone numbers for your convenience.
If you are interested in becoming a contracted behavioral health provider with AmeriHealth Caritas Florida, please complete the Request to Contract form (PDF) to get started. You can also contact Provider Services at 1-800-617-5727.
AmeriHealth Caritas Florida members are treated with a holistic approach, integrating care to address their physical and behavioral health needs. We work with the appropriate primary care provider and behavioral health providers to develop an integrated treatment plan. We understand that the coordination of care for these members experiencing comorbid conditions is imperative. Care managers will facilitate communication between physical and behavioral health providers routinely and with appropriate consent. For care coordination assistance, behavioral health providers may contact the AmeriHealth Caritas Florida Rapid Response and Outreach team at 1-855-371-8072.
Authorization for outpatient services. For Psychological Testing and Neuropsychological Testing, providers can request prior authorization in two different ways.
- Submit the prior authorization request in NaviNet.
- Complete the Psychological/Neuropsychological Testing Request form (PDF) and then fax the form to 1-855-236-9285.
For electroconvulsive therapy treatment (ECT), authorization review is done telephonically by calling at 1-855-371-8074.
Authorization for higher levels of care, including intensive outpatient program (IOP), partial hospitalization program (PHP), inpatient program (IP), detoxification, statewide inpatient psychiatric program (SIPP) and rehabilitation:
- Complete the Behavioral Health Fax form (PDF) then fax the form to 1-855-236-9293.
- Contact Utilization Management (UM) at 1-855-371-8074. For urgent precertification requests for acute care, UM is available 24/7.
Prior authorization is required before the service is provided.
AmeriHealth Caritas Florida follows all timeliness requirements for prior authorization requests, which include making a determination in 7 days for a standard request and in 2 days for an expedited request.
AmeriHealth Caritas Florida uses InterQual as the medical necessity criteria for behavioral health. The American Society of Addiction Medicine (ASAM) medical necessity criteria is used for substance use treatment.
It is very important for every member being discharged from an inpatient unit to be seen for a follow-up appointment within 7 days. Please make every effort to accommodate these requests for discharge appointments.
AmeriHealth Caritas Florida encourages telehealth to increase access to care for members. To help ensure compliance with the telehealth requirements, providers need to review and sign the Telehealth Attestation, available at Telehealth attestation (PDF). When billing, providers should include the GT modifier to indicate the service was done via telehealth.
- Telehealth attestation (PDF)
- Behavioral health subspecialty checklist (PDF)
- Psychological/Neuropsychological testing request form (PDF)
- Behavioral health fax form (PDF)
- Adult high dose antipsychotic (PDF)
- Antidepressants (<6 years of age) (PDF)
- Antipsychotics (<6 years of age) (PDF)
- Antipsychotics (Age 6 to <18 years of age) (PDF)