AmeriHealth HMO, Inc. and AmeriHealth Insurance Company of New Jersey (collectively, AmeriHealth) would like to explain the telebehavioral health services that are available to your patients (our members) and how to verify coverage for telebehavioral health services.
Accessing telebehavioral health services
Your patients (our members) have two options for accessing telebehavioral health services:
Patients can locate licensed AmeriHealth telebehavioral health providers in the following ways:
Use the
Find a Doctor tool.
Call the number on the back of their ID card under Mental Health/Substance Abuse.
Check with their current provider to see if they offer virtual visit options.
Patients can access telebehavioral health services via Teladoc Health (Teladoc), an independent company that provides virtual care services. To register with Teladoc, patients can call 1-800-835-2362, visit
teladochealth.com, or download the Teladoc mobile app.
Verifying coverage for telebehavioral health services
Coverage for telebehavioral health services may vary among plans. It is important for providers to verify coverage prior to rendering telebehavioral health services. Providers can check a patient's behavioral health coverage on the Provider Engagement, Analytics & Reporting (PEAR) portal using the PEAR Practice Management (PM) application.
Copay information
Providers should follow the below steps to access copay information for telebehavioral health services.
Steps for members who have not yet transitioned to our next generation platform
Go to the
PEAR portal.
Select the Practice Management application.
Select
Eligibility & Benefits from the Transactions menu.
Enter the criteria to search for the member.
Select
Behavioral Health/Substance Abuse from the Benefits & Coverages tab.
Select
Conditions.
Find the copay amount listed under
Outpatient Mental Health Services.
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If a single Copay line exists, In-Office Copay and Telehealth Copay are the same.
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If the Telehealth Copay is different than the In-Office amount, you will see an additional copay line titled “Copay for Virtual Services." This will state either a different copay amount or that the copay is waived. If there is not an additional copay line for virtual services, then the copays are the same.
Steps for members
on our next generation platform (new ID number format issued)
Go to the
PEAR portal.
Select the Practice Management application.
Select
Eligibility & Benefits from the Transactions menu.
Enter the criteria to search for the member.
Select
Virtual Care from the
Benefits & Coverages tab.
For questions, please contact Provider Customer Service at 1-888-YOUR-AH1
(1-888-968-7241)
for AmeriHealth members in New Jersey or 1-800-275-2583 for AmeriHealth members in Pennsylvania.