Behavioral health is critical to a patient’s overall health. Thank you for the care and support you provide to your patients—our members.
Our behavioral health team provides support and assistance for members with substance use disorder or mental health needs. Whether you're an individual clinician, primary care provider or facility, we're dedicated to being a good partner.
We are working to close health equity gaps to ensure simpler, better, more affordable health care for those we serve—from all backgrounds and walks of life. Good health is influenced by the environments where your patients live, learn, work, play, worship and age. These factors—known as social determinants of health (SDoH)—affect health outcomes and may lead to medication non-compliance, hospital readmissions, unnecessary emergency department visits and other medical issues.
We encourage you to document SDoH ICD-10-CM Z codes during patient encounters. These supplemental diagnosis codes help us understand barriers to care and social risk factors, as well as helping us identify opportunities to support our members, such as through transportation or in-home care or by connecting members to food banks and other community resources.
- Publications: The Connection and The Bulletin include important news and changes to our policies.
- Our Administrative Manual contains policy and procedure information, including information for facilities.
- Our Medical Policy Manual provides guidelines for determining coverage criteria for procedures and facility admissions.
- Find forms for all levels of care, including pre-authorization for admissions, applied behavior analysis and transcranial magnetic stimulation.
- Ensure your information on our Find a doctor tool is current by verifying your information at least every 90 days.
- Review best practices for keeping clinical records
New in 2023: Learn about our Incident to Services (Administrative #148) commercial and Medicare Advantage reimbursement policies and more in our Reimbursement Policy Manual.
Provider reimbursement schedules and other pricing documents are available in Availity Essentials: Payer Spaces>Resources. You’ll also find eligibility, benefits and claims-related information for most members.
- All claims must be submitted electronically.
- All claims payments are made via electronic funds transfer (EFT).
- Learn how to identify members, easily submit claims and receive payment for services and supplies.
- Ensure your clinical notes are complete.
If you have had a pre-authorization request denied, consult the denial letter for any appeal process specific to the member's plan.
Submit appeals in Availity Essentials.
Learn more about pricing disputes and appeals.
Our Self-Service Tool is available 24/7 with answers to frequently asked questions. Availity Essentials has eligibility, benefits and claims-related information for most members. For other questions, call our Provider Contact Center.
Clinical Intake Operations
- Phone: 1 (800) 780-7881
- Fax: 1 (888) 496-1540
Join our Provider Advisory Council.