Prior Authorizations

AmeriHealth Caritas North Carolina will need to approve some treatments and services before you receive them. AmeriHealth Caritas North Carolina may also need to approve some treatments or services for you to continue receiving them. This is called prior authorization.

AmeriHealth Caritas North Carolina will honor your existing prior authorizations (prior approvals) for benefits and services for the first 90 days of your enrollment. If you have questions about prior authorizations, please call Member Services at 1-855-375-8811 (TTY 1-866-209-6421).

Prior authorization process

To request prior authorization, you or your provider can contact AmeriHealth Caritas North Carolina by calling Member Services at 1-855-375-8811 (TTY 1-866-209-6421). Providers can submit requests through the provider portal.

To get approval for these treatments or services, the following steps need to occur:

1. AmeriHealth Caritas North Carolina will work with your provider to collect information to help show us that the service is medically necessary.
2. AmeriHealth Caritas North Carolina nurses, health care providers and behavioral health clinicians review the information. They use policies and guidelines approved by the North Carolina Department of Health and Human Services to see if the service is medically necessary.
3. If the request is approved, we will let you and your health care provider know it was approved.
4. If the request is not approved, a letter will be sent to you and your health care provider giving the reason for the decision.
5. If you disagree with the decision, you may file a member appeal. Learn more on our Appeals page.