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25-1149 Behavioral Health Authorization Submission Guidelines

Date: 10/31/25

Use this guide to correctly submit authorization requests based on service type and line of business

Effective January 1, 2026, Availity Essentials will be the primary method to submit initial facility-based behavioral health services authorization requests for Ambetter HMO/PPO, Employer Group HMO, POS & PPO, and Wellcare By Health Net members.

Ensure a seamless start by January 1, 2026, with the steps below:

1 Register for an Availity Essentials account at Multi-Payer Portal Registration.

2 Get trained:

  • Log in to Availity Essentials.
  • Go to Help & Training > Get Trained > Sessions.
  • View and access webinars via the Availity Learning Center (ALC).

3 Submit initial authorization requests at Availity Essentials.

How to submit authorization requests

To ensure timely and accurate processing of behavioral health service authorizations, follow the submission guidelines below.

Need help?

Support type

Contact information

Availity Essentials Support

(For assistance with Availity Essentials registration or portal-related questions)

800-282-4548
(Mon–Fri, 5 a.m. – 5 p.m. PT)

Behavioral Health Provider Services

(For general behavioral health provider support)

844-966-0298

 

  • Preferred submission methods: Online via Availity Essentials or fax for faster authorization.
  • If you cannot submit your authorization online through Availity Essentials or by fax, a phone option is available.  Behavioral health providers can call 844-966-0298 for both pre-service and concurrent review authorization requests. Note: Written clinical documentation is required, except for post-stabilization care.

 

Service type

Submission method

Line of business

Facility-based behavioral health services
(initial request)

Availity Essentials
(primary method starting January 1, 2026)

  • Individual & Family Plans –IFP (Ambetter HMO/PPO)
  • Commercial (Employer Group HMO, POS & PPO)
  • Wellcare By Health Net (Medicare HMO)

Alternate submission (fax to 855-663-2244 using the appropriate form1)

Note: Written clinical documentation must accompany all authorization requests (except post-stabilization care). Fax documentation to 855-663-2244.

1Forms are available on the Prior Authorization, or in the Health Net Provider Library, under Forms and References

Contact your County Mental Health Plan.

County Mental Health Plan information is available through the Department of Health Care Services.

  • Medi-Cal

Authorization for post-stabilization care

Call 844-966-0298

  • Individual & Family Plans –IFP (Ambetter HMO/PPO)
  • Commercial (Employer Group HMO, POS & PPO)
  • Wellcare By Health Net (Medicare HMO)

Facility-based behavioral health services
(concurrent requests)

Starting January 1, 2026, concurrent authorization requests must be submitted via fax, using the appropriate form (available January 1, 2026, at Prior Authorizations).

More details about the form will be provided once available.

  • Individual & Family Plans –IFP (Ambetter HMO/PPO)
  • Commercial (Employer Group HMO, POS & PPO)
  • Wellcare By Health Net (Medicare HMO)

Transcranial magnetic stimulation (TMS)

Email

Fax: 855-661-0077

  • Individual & Family Plans –IFP (Ambetter HMO/PPO)
  • Commercial (Employer Group HMO, POS & PPO)
  • Wellcare By Health Net (Medicare HMO)
  • Medi-Cal

Neuropsychological testing

Email

Fax: 855-703-3268

Applied behavioral analysis (ABA)

Email

Fax: 855-427-4798

Routine psychotherapy or medication management with an in-network provider

No referral or prior authorization is required.

 

This information applies to Behavioral Health Providers.


 



Last Updated: 10/31/2025