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Behavioral Health Prior Authorizations

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

How to submit a prior authorization request for behavioral health services

By phone

  • Call Behavioral Health Utilization Management (UM) at 1-844-214-2474, 8 a.m. to 5:30 p.m., Monday through Friday.

By fax

For the initial prior authorization of inpatient stays, electroconvulsive therapy, partial hospitalization, and SUD rehab, please submit requests by telephone to the UM department. We also accept requests for other behavioral health levels of care by fax. Please make sure you submit all of the appropriate information to support a medical necessity review and/or level of care evaluation.

Requests to extend authorization on these services may also be submitted by telephone to the UM department.

Behavioral health services that require prior authorization

These behavioral health services require prior authorization review for medical necessity and place of service.

  • Electroconvulsive therapy (ECT).
  • Psychiatric in-patient services.
  • Psychoanalysis.
  • Psychological, neuropsychological, developmental testing — More than three hours.
  • Community support services.
  • Applied behavior analysis (ABA).
  • Behavioral health intervention services.
  • Psychiatric Medical Institutions for Children (PMIC) services.
  • Habilitation program services.
  • Intensive psychiatric rehabilitation services (IPR).
  • Assertive community treatment (ACT).
  • Intensive in-home behavioral health services.
  • Mental health day treatment.
  • Mental health and substance use disorder (SUD) peer support services.
  • Substance use disorder (SUD) residential programs
    • Clinically management low intensity.
    • Clinically management medium intensity.
    • Medically monitored intensive inpatient.
    • Medically managed intensive inpatient.
  • Substance use disorder (SUD) intensive outpatient program (Level 2.1) after initial 18 sessions.
  • Substance use disorder (SUD) partial hospitalization/day treatment program (Level 2.5).
  • Nursing facility — Special population.
    • Also known as Skilled Preapproval provided in out-of-state skilled nursing facilities.

Behavioral health services that do not require authorization/notification

  • 23-hour observations.
  • Behavioral health and substance use disorder (SUD) evaluations and assessments.
  • Behavioral health and substance use disorder (SUD) medical team conference.
  • Behavioral health and substance use disorder (SUD) medication evaluation, management, and consultation.
  • Behavioral health and substance use disorder (SUD) outpatient therapy (individual, family, group therapy sessions).
  • Behavioral health and substance use disorder (SUD) therapeutic injections.
  • Institute of public health (IDPH) substance use disorder services for all IDPH participants.
  • Mobile counseling.