Behavioral Health
Prior Authorization Requirement
For Licensed Individual Practitioners (LIPS) providers Rehabilitative Behavioral Health Services (RBHS) providers, prior authorization will be required starting June 1, 2019 for any combination of the following procedure codes for continued services after the 24th encounter within a calendar year per member: 90832, 90834, 90837, 90846, 90847, 90849, and 90853.
Additionally, for all provider types, Absolute Total Care will reset its benefit limits for all codes identified above to match the benefit limits currently outlined by the South Carolina Department of Health and Human Services (SCDHHS). For more details, click the button below to view the provider letter.
Beginning on April 27, 2018 Behavioral Health providers should access their secure provider portal at absolutetotalcare.com.
Through the secure provider portal you can:
- Check member eligibility
- Submit and manage claims
- Submit and view prior authorizations
- Review and download payment history
- View member gaps in care
- Secure Message absolutetotalcare.com
- Manage multiple accounts
For more information about the secure provider portal, visit the Login page.
If you have any questions, please call Absolute Total Care Provider Services at 1-866-433-6041.
**Note: Requests for additional days for existing authorizations or new requests prior to 10/24/22 please continue to submit to Absolute Total Care Appeals and Grievances team by faxing: 866-918-4457.
Authorization requests for this level of treatment should now be faxed to: 866-535-6974 for medical necessity review or submit via ATC Secure Provider Portal.
This information is required to process these requests:
- Inpatient BH Initial Review Form (PDF)
- SCDHHS Certification of Need Psychiatric Hospital Services/Certificate of Need (PDF)
- Psychiatric evaluations or diagnostic assessment
- Name of facility that will be accepting the member
- Date of admission within one (1) week of the request
- Clinical information to support this level of care
Initial requests, notifications and/or clinical documentation will no longer be accepted via email effective October 24, 2022.
PRTF requests will be reviewed using InterQual medical necessity criteria (Currently 2022 edition)
Denied services will follow the current Absolute Total Care Grievance and Appeals process. Please visit the Grievances and Appeals landing page for additional information.
Grievances and Appeals - Providers
Additional Resources:
Practice Guidelines
Click the link below for The American Psychiatric Association Practice Guidelines for Pharmacological Treatments.
Behavioral Health Forms
- Outpatient BH Autism Spectrum Disorder (ASD) Authorization Form (PDF)
- Outpatient BH Treatment Request Form (PDF)
- Inpatient BH Initial Review Form (PDF)
- Inpatient BH Concurrent Review Form (PDF)
- Inpatient BH Substance Abuse Disorder Initial Review Form - Adult (PDF)
- Inpatient BH Substance Abuse Disorder Concurrent Review Form - Adult (PDF)