Prior Authorization Requirements
Some outpatient services require prior authorization. For psychological testing and neuropsychological testing, providers can request prior authorization in two different ways.
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.
Prior 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, can be requested as shown below:
- 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 seven days for a standard request and in two days for an expedited request.
Clinical Medical Necessity Criteria
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.
Quality Initiative for IP discharges
It is very important that every member being discharged from an inpatient unit is seen for a follow-up appointment within seven days. Please make every effort to timely accommodate your patients’ requests for discharge appointments.