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NC Medicaid will delay Tailored Plan launch beyond October 2023. A new launch date has not been announced.

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Provider Support: 855-759-9700
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Medicaid - Child and Adolescent Day Treatment

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About

Coverage Information Icon

Medicaid B

Diagnosis Group(s) Information Icon

Mental Health, Substance Use, Developmental Disability

Age Group(s) Information Icon

Child, 18-20

Reference Documents

Authorization

Submission Requirements Information Icon

Initial:

  • Service Authorization Request (SAR)
  • Person Centered Plan (PCP) with Service Order
  • Comprehensive Clinical Assessment (CCA)

Concurrent:

  • Service Authorization Request (SAR)
  • Updated Person Centered Plan (PCP)

Service Definition Authorization Parameters Information Icon

  • 60 day authorization periods up to 129 units per month

ASAM Level of Care Information Icon

2.1

Request Prior Approval from Alliance Health

Service Codes & Descriptions

  • H2012 HA U5 Co-occurring DayTx for up to 8 youth
  • H2012 HA- Day Tx Behavioral Health Child
  • H2012HA22 - Child and Adolescent Day Treatment Provided During Disaster or Emergency
  • H2012 HA CR- Day Tx Behavioral Health Child
  • H2012 HA-GT CR Day Tx Behavioral Health Child

Full Service Definition

<a target="_blank" href="https://medicaid.ncdhhs.gov/8a-enhanced-mental-health-and-substance-abuse-services/download?attachment">Download PDF</a>
Download PDF

Alliance Statement of Work

Alliance Provider Support is available to answer provider questions about authorization, billing, claims, enrollment, ACS, or other issues.

Call 855-759-9700 Monday-Saturday from 7:00am-6:00pm.