AmeriHealth Caritas NC Medicaid: Behavioral Health Billing Guide
AmeriHealth Caritas North Carolina went the other direction from most plans: on January 1, 2025 it removed prior authorization and notification requirements from more than 240 physical and behavioral health codes. Practices still requesting authorizations it no longer needs are spending staff time for nothing.
Short answer
AmeriHealth Caritas North Carolina is an NC Medicaid Standard Plan. As of January 1, 2025, it eliminated prior authorization and notification requirements for more than 240 physical and behavioral health procedure codes, no longer requires notifications for behavioral health codes, and relaxed requirements for services including facility-based crisis treatment for children and adolescents, mobile crisis management, and outpatient treatment. Authorizations that remain go through NaviNet.
Where AmeriHealth Caritas fits
AmeriHealth Caritas North Carolina is one of North Carolina's Standard Plans, which cover most NC Medicaid members with physical and behavioral health together. Members with significant behavioral health, substance use, I/DD, or TBI needs are served by Tailored Plans instead, so confirm the member's plan in NCTracks before assuming Standard Plan rules apply.
What changed in 2025
Effective January 1, 2025, AmeriHealth Caritas North Carolina eliminated prior authorization and notification requirements for more than 240 procedure codes across physical and behavioral health. Notifications are no longer required for behavioral health codes, and requirements were relaxed for more than a dozen services, including facility-based crisis treatment for children and adolescents, mobile crisis management, and outpatient treatments. Use the plan's Prior Authorization Lookup Tool to confirm whether a specific code still needs review.
| Contact | Detail |
|---|---|
| Prior authorization online | NaviNet, including Jiva for authorizations |
| Lookup | Prior Authorization Lookup Tool on the plan's provider site |
| Provider Services | 1-888-738-0004 |
As of October 2026.
Where behavioral health claims go wrong
- Requesting authorizations no longer required. Staff time spent on reviews the plan removed in 2025.
- Assuming everything was removed. Codes that still need authorization billed without it. Check the lookup tool.
- Member is in a Tailored Plan. Behavioral health billed to AmeriHealth Caritas for a Tailored Plan member.
Related: verifying NC Medicaid eligibility in NCTracks, associate-level clinician billing in NC, and the NC Medicaid behavioral health billing guide.
Sources, checked October 2026: AmeriHealth Caritas NC behavioral health prior authorization reductions; AmeriHealth Caritas NC prior authorization reference guide. Confirm current details on the plan's provider site.
Frequently asked questions
Does AmeriHealth Caritas NC require prior authorization for behavioral health?
Far less than before. As of January 1, 2025, it removed prior authorization and notification requirements for more than 240 codes, including behavioral health notifications. Some services still require authorization; check the Prior Authorization Lookup Tool.
How do I submit a prior authorization to AmeriHealth Caritas NC?
Electronically through NaviNet, which includes Jiva for authorizations, or by phone or fax as described in the plan's prior authorization guide.
What is AmeriHealth Caritas NC's provider services number?
1-888-738-0004, as of October 2026.
Does AmeriHealth Caritas NC still require behavioral health notifications?
No. As of January 1, 2025, notifications are no longer required for behavioral health codes.
Only the authorizations you actually need.
See Stable check each AmeriHealth Caritas claim against current authorization rules, so your team stops requesting reviews the plan removed.
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