Behavioral Health Programs

At AmeriHealth Caritas Florida, we work with providers to help members get the services they need for behavioral health condition, substance use disorders and co-occurring illnesses.

Integrating behavioral and physical health

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, PCPs and behavioral health providers may contact the AmeriHealth Caritas Florida Rapid Response and Outreach team (RROT) at 1-855-371-8072.

Substance use treatment

  • Medication management services
  • Medication for opioid use disorder ([MOUD] formerly known as MAT)
  • Medication for alcohol use disorder (AUD)
  • Primary Care-Based Treatment
  • Ambulatory detoxification services
  • Alcohol and drug intensive outpatient programs (IOP)
  • Alcohol and drug partial hospitalization programs (PHP)

Need support now?

If you or someone you know is struggling or in crisis, help is available. Call or text 988.

Intensive outpatient programs (IOPs)

These are supervised, structured treatment services provided to members who need more than outpatient treatment services, or as an alternative to outpatient treatment.

Day treatment/partial hospitalization programs (PHPs)

These are structured and supervised intense treatment programs that provide frequent monitoring/management of the member’s medical and emotional concerns to avoid the need for hospitalization. The program has access to psychiatric, medical, and laboratory services. Intensive services at this level of care provide additional clinical support in a community setting.

This two-page guide (PDF) provides information you need to successfully submit claims, get paid quickly, request authorization, and find important phone numbers.

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.

Authorization for outpatient services. For Psychological Testing and Neuropsychological Testing, providers can request prior authorization in two different ways.

  1. Submit the prior authorization request in NaviNet. 
  2. 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 1-855-371-8074.

To obtain 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:

  1. Complete the Behavioral Health Fax form (PDF) and send the form to 1-855-236-9293.
  2. 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; to make a determination in 7 days for a standard requests and 2 days for expedited requests.

Prior Authorization Request Form (general) (PDF)

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 and again 30 days post-discharge. Please make every effort to accommodate and prioritize these requests for follow-up appointments to improve patient outcomes.

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 (PDF). When billing, providers should include the GT modifier to indicate the service was done via telehealth.

Providers