AmeriHealth
Effective Jan. 1, 2024, you will need to be contracted with AmeriHealth to provide behavioral health services to their members as an in-network provider.
Continue to contact Magellan to request authorization of applied behavior analysis (ABA) services for AmeriHealth members through Dec. 31, 2025.
Applied Behavior Analysis
- For autism-related forms, sign in to this website. From the Resources section, select State & Plan Information, then choose Autism-Specific Information to access:
- ABA Initial Authorization
- ABA Treatment Plan/Concurrent Review
For all other behavioral health requests, contact AmeriHealth at the number on the member’s ID card, except for AmeriHealth Administrators GeoBlue Pennsylvania Commercial plans.
For authorization information for GeoBlue Commercial members, see below.
Pennsylvania
Prior Authorization Process for GeoBlue Pennsylvania Commercial Plans
Medical Necessity Criteria/Medical Policy
Substance use disorder:
- American Society of Addiction Medicine (ASAM) and An Introduction to The ASAM Criteria for Patients and Families (PDF) - Licensee's use and interpretation of the American Society of Addiction Medicine’s ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits.
Applied behavior analysis, transcranial magnetic stimulation, and psychological testing:
Other mental health services:
- Additional criteria are available here.
Prior Authorization Requirements
Requesting Prior Authorization
Some facility and non-routine outpatient services may be requested online via the Request Member Care application.
- Sign into this website and select Request Member Care from the left-hand menu.
- If the provider portal (Request Member Care app) is not available, you may contact Magellan at 1-800-778-2119 for authorization of services to GeoBlue Commercial members.
Tutorials:
- Request Member Care – Facility services
- Request Member Care – Non-routine outpatient services
User guides:
- Request Member Care – Facility services (PDF)
- Request Member Care – Non-routine outpatient services (PDF)
For services that require prior authorization and are not accessible through the Request Member Care application, complete the appropriate form below and fax it to Magellan.
- For autism-related forms, sign in to this website. From the Resources section, select State & Plan Information, then choose Autism-Specific Information to access:
- ABA Initial Authorization
- ABA Treatment Plan/Concurrent Review
- Psychological Testing Preauthorization Request Form (PDF)
- ECT Authorization Request Form (PDF)
- TMS Authorization Request Form (initial and concurrent, PDF)
- Fax number for completed form submissions:
- ABA: 1-888-656-4925
- Psychological testing and ECT: 1-888-656-0259
- TMS: 1-888-656-4967
- Customer service numbers:
- AmeriHealth Administrators GeoBlue: 1-800-778-2119
- Provider Services Line: Chat with us or contact us at 1-800-788-4005 for technical issues with the website.
Requesting a Peer-to-Peer Consultation
To request a peer-to-peer consultation, contact Magellan’s Utilization Management Support Team at 1-800-741-2304, option 3, then Option 2.
- Peer-to-peer process (PDF)
New York
Notice to inpatient providers in New York who serve GeoBlue members, an AmeriHealth Administrators plan (PDF)
State of Washington
Preauthorization requirements for GeoBlue members, an AmeriHealth Administrators plan (PDF)