This two-page guide (PDF) provides information you need to successfully submit claims, get paid quickly, request authorization, and find important phone numbers for your convenience.
Effective January 1, 2021, the management of behavioral health and substance use benefits will transition from Optum Behavioral Health to Prestige Health Choice for all current Prestige Health Choice members in Florida (Medicaid Regions 9 and 11).
Participating Prestige providers
Participating Prestige Health Choice providers are eligible to continue providing services for our members and to receive new member referrals. Please continue to accept Prestige Health Choice members and provide services as you normally do for our members. Remember to submit all of your claims for dates of service on or after January 1, 2021 to Prestige Health Choice Payer ID #77003. You will be reimbursed for covered services according to the payment provisions in your agreement with Prestige.
Prestige Health Choice members must receive their behavioral health services from a Prestige Health Choice participating provider to use their benefits, with limited exception. For more information on how to join our network, please complete the Request to Contract form to get started: http://www.prestigehealthchoice.com/provider/join-our-network.aspx.
Transition of care
If your Prestige Health Choice member is receiving covered services prior to January 1, 2021, there is a transition benefit available covering nonparticipating providers. Members have a continuity of care (COC) period where they are allowed to continue receiving medically necessary services for ninety (90) days after the Optum contract termination on 12/31/2020, or the completion of treatment if that’s sooner.
If you are interested in becoming a contracted behavioral health provider with Prestige Health Choice, please complete the Request to Contract form to get started: http://www.prestigehealthchoice.com/pdf/provider/forms/request-contract-form.pdf. You can also contact Provider Services at 1-800-617-5727.
Prestige Health Choice members are treated with a holistic approach, integrating care to address their physical and behavioral health needs. We work with the appropriate primary care provider and behavioral health providers to develop an integrated treatment plan. We understand that the coordination of care for these members experiencing comorbid conditions is imperative. Care managers will facilitate communication between physical and behavioral health providers routinely and with appropriate consent. For care coordination assistance, behavioral health providers may contact the Prestige Rapid Response and Outreach team at 1-855-371-8072.
REMINDER: for Behavioral Health services follow the pre-authorization process for Prestige when requesting services on or after 1/1/2021. For services prior to 1/1/2021, request pre-authorization from Optum following their process.
Authorization for outpatient services. For Psychological Testing and Neuropsychological Testing, providers can request prior authorization in two different ways.
- Submit the prior authorization request in Availity.
- Complete the Psychological/Neuropsychological Testing Request form (PDF) and then fax the form to 1-855-236-9285.
For electroconvulsive therapy treatment (ECT), authorization review is done telephonically by calling at 1-855-371-8074.
Authorization for higher levels of care, including intensive outpatient program (IOP), partial hospitalization program (PHP), inpatient program (IP), detoxification, statewide inpatient psychiatric program (SIPP) and rehabilitation:
- Complete the Behavioral Health Fax form (PDF) then fax the form to 1-855-236-9293.
- Contact Utilization Management (UM) at 1-855-371-8074. For urgent precertification requests for acute care, UM is available 24/7.
Prior authorization is required before the service is provided.
Prestige Health Choice follows all timeliness requirements for prior authorization requests, which include making a determination in 7 days for a standard request and in 2 days for an expedited request.
Prestige Health Choice uses InterQual as the medical necessity criteria for behavioral health. The American Society of Addiction Medicine (ASAM) medical necessity criteria is used for substance use treatment.
It is very important for every member being discharged from an inpatient unit to be seen for a follow-up appointment within 7 days. Please make every effort to accommodate these requests for discharge appointments.
Prestige Health Choice encourages telehealth to increase access to care for members. To help ensure compliance with the telehealth requirements, providers need to review and sign the Telehealth Attestation, available at Telehealth attestation (PDF). When billing, providers should include the GT modifier to indicate the service was done via telehealth.
- Telehealth attestation (PDF)
- Behavioral health subspecialty checklist (PDF)
- Psychological/Neuropsychological testing request form (PDF)
- Behavioral health fax form (PDF)
- Adult high dose antipsychotic (PDF)
- Antidepressants (<6 years of age) (PDF)
- Antipsychotics (<6 years of age) (PDF)
- Antipsychotics (Age 6 to <18 years of age) (PDF)