​​AmeriHealth is insourcing Utilization Management services for Behavioral Health on April 1​

March 10, 2023

​On April 1, 2023, AmeriHealth HMO, Inc. and AmeriHealth Insurance Company of New Jersey (collectively, AmeriHealth) will start performing its own utilization management services for behavioral health. These services will replace those that are provided by Magellan Health Services (Magellan).

The change will apply to all behavioral health providers, whether contracted with AmeriHealth and/or Magellan. The only exception is Applied Behavioral Analysis (ABA) providers, who will continue to be serviced by Magellan.

This is part of our new approach to behavioral health, which takes a member's whole health and their equitable access to care into account. It is intended to help guide care journeys for our members that have more acute and chronic care needs. It will also ensure seamless handoffs to AmeriHealth case managers for follow-up support.

Not changing on April 1:

  • The phone number you call to obtain an authorization: It remains the same: 1-800-688-1911.
  • Services that require prior authorization: Inpatient services, residential treatment, partial hospitalization, intensive outpatient, ABA services, and Transcranial Magnetic Stimulation (TMS) services.
  • The responsibility you have to provide a Notice of Admission in accordance with state law (Chapter 28): This is still required.
  • The process for emergency authorizations remains in place: Hospitals are required to notify AmeriHealth of all emergency admissions within two business days of admission. When submitting the initial authorization request for an emergency inpatient admission, we require that a full 24-48 hours of clinical treatment and patient response be provided. This information can be submitted to us via phone or fax. Upon receipt, we will provide a determination within one business day.
  • Utilization management services for ABA: These will remain with Magellan and will use Magellan's criteria.

Changing on April 1:

  • Who you talk to when you call 1-800-688-1911: When you call to obtain an authorization, you will speak to an AmeriHealth authorization intake specialist rather than a Magellan representative.
  • Who completes the review process for inpatient cases: The Magellan team will complete the review process for all inpatient cases received prior to April 1 – up through patient discharge or 30 days from the start of the stay, whichever comes first. Any requests submitted to AmeriHealth on or after April 1 will be reviewed against criteria aligned with InterQual® and American Society of Addiction Medicine (ASAM) evidence-based medicine practices. This may be different than the proprietary Magellan criteria used previously.
  • Who completes the review process for all other cases: The Magellan team will complete the review process for all requests received prior to April 1, and AmeriHealth will complete the review process for all requests received on or after April 1.

Our commitment to Behavioral Health

Last June, AmeriHealth established its own behavioral health case management services. This is a function previously handled by Magellan. Our Behavioral Health Case Managers have been successfully providing case management services to your patients, our members, for more than eight months.

Further, AmeriHealth established and is managing its own network of behavioral health providers. The network went into effect January 1, 2023. We continue to work closely with Magellan during this transition.

Also on April 1, 2023, AmeriHealth will begin overseeing its own customer service for behavioral health. These services will replace customer service support that was previously provided by Magellan.

Members will still use the phone number on the back of their ID card. However, customer service support will be provided by specially trained Behavioral Health Customer Care Advocates. This will help us screen members for mental and behavioral health conditions, as well as connect them to care that best suit their unique needs.

Behavioral Health providers whose associated practices have not yet signed a Provider Agreement with AmeriHealth are encouraged to complete a credentialing application for AmeriHealth Pennsylvania or AmeriHealth New Jersey. This is the first step in the process required for obtaining a contract and getting set up.

For more information on contracting with the AmeriHealth Behavioral Health network, please contact us at amerihealthbh@amerihealth.com.​