Healthy Blue NC Medicaid: Behavioral Health Billing and Prior Authorization
Healthy Blue is one of North Carolina's largest Standard Plans, and its behavioral health authorizations run through Availity rather than a plan-specific portal. It also publishes a list of behavioral health revenue codes that always need prior authorization, which is the single most useful thing to know before billing it.
Short answer
Healthy Blue is an NC Medicaid Standard Plan. Behavioral health prior authorizations are requested and checked through the Interactive Care Reviewer in Availity, or started by phone through Provider Services at 844-594-5072. Services billed with revenue codes 0240 to 0249, 0513, 0901, 0905 to 0907, 0913, 0917, 0944 to 0945, and 0961 always require prior authorization.
Where Healthy Blue fits
Healthy Blue 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.
Prior authorization
Healthy Blue routes prior authorization through the Interactive Care Reviewer (ICR) in Availity: choose Patient Registration, then Authorizations & Referrals. Requests can also be started by phone through Provider Services, including urgent requests.
| Revenue codes | Service type |
|---|---|
| 0240 to 0249 | All-inclusive ancillary psychiatric |
| 0513 | Psychiatric clinic |
| 0901, 0905 to 0907, 0913, 0917 | Behavioral health treatment services |
| 0944 to 0945 | Other therapeutic services |
| 0961 | Psychiatric professional fees |
Healthy Blue lists services billed with these revenue codes as always requiring prior authorization.
| Contact | Detail |
|---|---|
| Provider Services | 844-594-5072, Monday to Saturday, 7 a.m. to 6 p.m. ET; voice portal 24/7 |
| Authorizations online | Interactive Care Reviewer in Availity |
Where behavioral health claims go wrong
- Revenue-code services without authorization. Facility and program services on the always-authorized list billed with no auth on file.
- Member is in a Tailored Plan. Claims for members whose behavioral health belongs to a Tailored Plan.
- Clinician not credentialed with Healthy Blue. Network status assumed from another plan.
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: Healthy Blue prior authorization requirements; Healthy Blue provider resources. Confirm current details on the plan's provider site.
Frequently asked questions
Does Healthy Blue NC require prior authorization for behavioral health?
For many services, yes. Services billed with revenue codes 0240 to 0249, 0513, 0901, 0905 to 0907, 0913, 0917, 0944 to 0945, and 0961 always require it. Check Healthy Blue's current requirements for other codes.
How do I submit a prior authorization to Healthy Blue NC?
Through the Interactive Care Reviewer in Availity, under Patient Registration, then Authorizations & Referrals, or by phone through Provider Services at 844-594-5072.
What is Healthy Blue NC's provider services number?
844-594-5072, Monday to Saturday, 7 a.m. to 6 p.m. ET, as of October 2026.
Is Healthy Blue a Standard Plan or a Tailored Plan?
A Standard Plan. Members with significant behavioral health, substance use, I/DD, or TBI needs are in Tailored Plans instead.
Healthy Blue's rules, applied before submission.
See Stable check Healthy Blue's authorization requirements on every behavioral health claim before it goes out.
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