Behavioral Health Prior Authorizations

AmeriHealth Caritas Ohio providers may need to receive prior authorization before administering some behavioral health services to members.

Behavior health prior authorization form (PDF)

Submit a prior authorization request for behavioral health services

By phone

  • 1-833-735-7700 from 8 a.m. to 5 p.m., Monday to Friday
  • 1-833-764-7700 after hours, weekends, and holidays

By fax

  • 1-833-329-6411

Online

  • Providers can also use Jiva for online prior authorization via our secure provider portal by signing on to NaviNet and accessing the Jiva portal.

Forms

Behavioral health services requiring prior authorization

Behavioral health services requiring prior authorization

  • Adult (21 and over) Inpatient Hospitalizations (mental health and/or substance use disorder)
  • Psychological and neuropsychological testing
  • Electroconvulsive therapy
  • Assertive Community Treatment
  • Behavioral Analysis Therapy for Autism Spectrum Disorder
  • Substance Use Disorder Partial Hospitalization Program (ASAM 2.5)
  • Substance Use Disorder Residential Treatment (ASAM 3.1, 3.5, 3.7)
    • First and second admissions in a calendar year require a notification and are not subject to a medical necessity review
    • 31+ days during either admission requires a prior authorization and medical necessity review
    • Third and subsequent admissions in a calendar year require a prior authorization and medical necessity review
  • Unlisted Psychiatric Services

Services covered by OhioRISE ONLY:

  • Child and Adolescent Inpatient Hospitalization (mental health and/or substance use disorder)
  • Intensive Home-Based Treatment (IHBT)
  • Intensive and Moderate Care Coordination
  • Psychiatric Residential Treatment Facility
  • OhioRISE 1915(b) and 1915(c) services

Services requiring notification

  • Substance Use Disorder Residential Treatment (ASAM 3.1, 3.5, 3.7)
  • First and second admissions in a calendar year require a notification and are not subject to a medical necessity review.
  • If either admission is for 31 or more days, it requires a prior authorization and medical necessity review.
  • Third and subsequent admissions in a calendar year require a prior authorization and medical necessity review.
  • Mobile Response and Stabilization Services (MRSS) require notification within 72 hours of initiation.

Behavioral health services that do not require authorization

  • Psychotherapy for Mental Health and Substance Use Disorder: Individual, Family, Multiple-family, Group
  • Psychotherapy for Crisis for Mental Health and Substance Use Disorder
  • Behavioral Health Counseling
  • Psychosocial Rehabilitation Services
  • Community Psychiatric Supportive Treatment (Individual and Group)
  • Therapeutic Group Services
  • Substance Use Disorder Assessment
  • Substance Use Disorder Individual and Group Counseling
  • Substance Use Disorder Case Management
  • Substance Use Disorder Urine Drug Screen Withdrawal Management ASAM 2-WM
  • Clinically Managed Residential Withdrawal Management ASAM 3.2-WM
  • Medically Monitored Inpatient Withdrawal Management ASAM 3.7-WM
  • Substance Use Disorder Intensive Outpatient Program (ASAM 2.1)
  • Substance Use Disorder Peer Support Services (up to 4 hours per day)
  • Evaluation and Management Visits for Mental Health and Substance Use Disorder including home and prolonged visits
  • Psychiatric Diagnostic Evaluation 
  • Smoking and Tobacco Cessation Counseling
  • Screening, Brief Intervention and Referral to Treatment (SBIRT)
  • A Child and Adolescent Needs and Strengths (CANS) assessment
  • Up to 72 hours of Mobile Response Stabilization Services (MRSS), except in accordance with OAC rule 5160-27-13.
  • Depression Screening and Cognitive Behavioral Health Therapies provided in coordination with the Help Me Grow program including services performed in the home. The AmeriHealth Caritas Ohio Population Health team will assist the member with arranging for depression screening and cognitive behavioral health therapies for members enrolled in the Help Me Grow program who are either pregnant or the birth mother of an infant or toddler under three years of age.
Providers