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Behavioral Health

Prior Authorization Guidance

Please Note: When a person-centered plan (PCP) is required per Clinical Coverage Policy for a service, providers should reference PCP guidance documents on the State website.

Please also refer to Clinical Coverage Policies for service specifics related to PCP documentation. Even if an update is not required for a PCP, providers still need to provide documentation of progress towards goal and current clinical information when submitting authorization requests in order for ongoing medical necessity of services to be determined. This will assist with more timely processing of requests.”

Behavioral Health Resources

Research Based Intensive Behavioral Health Treatment (RB-BHT) Applied Behavioral Analysis (ABA) Provider Guides

For clinical coverage requirements, refer to Policy 8F; Research Based Intensive Behavioral Health Treatment (RB-BHT) for Autism Spectrum Disease (ASD) (PDF)

HEDIS® Guides

Follow-Up After Hospitalization for Mental Illness (FUH) Resources

Initiation and Engagement of Substance Use Disorder Treatment (IET)

Toolkits and Trainings

Purpose: The purpose of the trainings are for medical and behavioral health providers to recognize the intent of the Behavioral Health HEDIS measures and share strategies to impact quality care and outcomes for members.

Target Audience: Medical and Behavioral health Providers, including licensed and unlicensed health care professionals and office staff.

Duration: 8-10 mins each

  1. Initiation and Engagement, Follow-Up After Emergency Department or High Intensity Care for Substance Use Disorders: Optimizing the IET, FUA, and FUI HEDIS® measures
  2. Strategies to Improve Cardiovascular, Diabetes, and Metabolic Monitoring: APM, SSD, SMC, and SMD HEDIS® Measures
  3. Follow-Up Care After a Hospital or Emergency Department Visit for Mental Illness: Optimizing the FUH and FUM HEDIS® Measures

Behavioral Health HEDIS® Training: ADD and APP HEDIS® Measures

Follow-Up Care for Children Prescribed Medication for ADHD and the Use of Psychosocial Care for Children and Adolescents Prescribed Antipsychotic Medications: Optimizing the Impact of the ADD and APP HEDIS® Measures

Carolina Complete Health offers trainings for both behavioral health and physical health providers in our network at no cost. Our team provides mostly clinical, provider-focused education on topics that are geared towards improving member outcomes. The majority of our clinical trainings also offer behavioral health continuing education units also at no cost to the attendee. Trainings are completed via live/virtual instructor led webinars.

How to sign up for trainings:

  1. View the lists of all upcoming trainings: (both are open to all providers)
  2. Select the training date and time that you would like to attend
  3. Enter the required information and click “Register”
  4. You will receive a confirmation email with a link and instructions for joining the webinar.
    NOTE: Please check your junk folder if you do not receive the confirmation email.
  5. When you join the webinar, the call-in telephone number and an attendee passcode will be displayed.

Training topics include but are not limited to:

  • Adverse Childhood Experiences (ACEs)
  • ASAM Overview
  • Topics in Behavioral Health
    • Anxiety
    • Bipolar
    • Depression
    • PTSD
    • Schizophrenia
  • BH Screening Tools
  • Behavior Management/ De-escalation
  • Care Coordination/Integrated Health
  • Cultural Competency/Cultural Humility
  • Dementia
  • Disability Sensitivity
  • DSM 5
  • Mental Health First Aid (MHFA)
  • Screening Brief Intervention and Referral to Treatment (SBIRT)
  • Social Determinants of Health
  • Substance Use Disorders Topics
    • SUD Overview
    • Alcohol
    • Caffeine
    • Cannabis
    • Hallucinogens
    • Inhalants
    • Opioids
    • Sedatives
    • Stimulants
    • Nicotine
    • Non Substance Related Disorders
  • Suicide Risk Assessment
  • Trauma Informed Care
  • Violence Prevention

For training requests and/or more information, please contact our Clinical Provider Training Department at: BH_training@centene.com.

METS (Members Empowered to Succeed) Program

The METS (Members Empowered to Succeed) program takes a unique approach to member care. We partner with the provider and member to ensure that the member achieves the ultimate level of recovery and resiliency. Our Clinical Liaisons work directly with providers to identify the member’s treatment and supports needed for successful progress in treatment. The Clinical Liaison assists with coordination of care when multiple providers are involved to ensure cohesive communication. Additionally, our Service Coordinators assist with identification of resources to meet the member’s behavioral health, social, and medical needs. Focusing on the member’s individualized needs creates a recovery roadmap that is as unique as the individual member. METS is available for select Carolina Complete Health Medicaid members.

Partnerships in Care (PiC) Program

Our Partnerships in Care (PiC) program uses data analytics and clinical reviews to enhance our partnership with you as the provider to maximize treatment successes. This approach is based on our philosophy that quality member care is achieved through purposeful collaboration with providers that serve our members receiving a multitude of behavioral health services.

If you are identified as a provider that could benefit from participation in the Partnerships in Care program through a data analysis, we will review members’ clinical documentation then collaborate with you to highlight areas of strengths and opportunities.

Page Last Updated: 10/28/2024