Gain Corporate Compliance or Fraud Knowledge

Provider Resources

Note: All contents are in PDF format. Help with PDF downloads

ABH Provider Handbook
Protecting Member Privacy
Corporate Compliance/Fraud, Waste and Abuse
Florida Medicaid Preferred Drug List
Assessment and Treatment of Major Depression
BCI Adult Care Coordination
BCI Youth Care Coordination
REACH Provider Referral Form
Florida Medicaid Compliance Training Materials - Humana

Level of Care Clinical Criteria

Note: The material provided are guidelines used by this plan to authorize, modify, or deny care for persons with similar illnesses or conditions. Specific care and treatment may vary depending on individual need and the benefits covered under your contract.

Mental Health Level of Care Criteria
Substance Abuse Level of Care Criteria
SIPP Level of Care Criteria

ABH Affirmative Statement Regarding UM Decisions

UM decision making is based only on appropriateness of care and service and existence of coverage.
Access Behavioral Health does not specifically reward practitioners or other individuals for issuing denials of coverage or care.
Access Behavioral Health does not use financial incentives for UM decision makers to encourage decisions that result in underutilization.