Behavioral Health Prior Authorization Submission Effective October 1, 2020

Date: 10/27/20

Thank you for your continued partnership with Ambetter from IlliniCare Health insured by Celtic Insurance Company (Ambetter from IlliniCare Health). We work to ensure that it is always easy to do business with Ambetter, and we want to notify you of some upcoming changes to our behavioral health prior authorization forms.

Summary of Change: Effective October 1, 2020, we will be converting to a new prior authorization form for behavioral health services. *NOTE*: The fax number to submit a behavioral health request has changed to 1-844-273-2331.

Why are these changes necessary? Our current “Outpatient Treatment Request” form is several pages long and confines you to our form’s format for supporting clinical documentation. Our new “Prior Authorization Form” is a single page and will allow you to submit clinical data in any form.

What are the impacts of these changes? When we switch to the new form we will also post parameters for supporting clinical documentation to help ensure that what you submit will provide the information we need to make a determination.

What if I need assistance? The new form will be posted on the Provider Resources page of our website. Please don’t hesitate to reach out to our Provider Services team at 1-855-745-5507 with any questions you may have.

Please fax BH Prior Authorization Submissions to 1-844-273-2331.

This information is also reflected in our Provider Manual. For access to the current provider manual, please visit our website.

Sincerely,
Ambetter from IlliniCare Health