Behavioral Health Provider Resources
Meridian is focused on enhancing behavioral health (BH) services for our members by offering tailored programs, resources, and education to support providers and care teams.
Care Coordination
Connecting members to care and resources
Our Care Coordination program helps connect members to the care they need. The goal of care coordination is to improve members’ overall physical and behavioral health while also addressing their health-related social needs.
Care Coordination can benefit everyone, especially members who:
- Have chronic behavioral and/or physical health problems
- Have difficulty accessing the care they need
- Require specialized care or see multiple providers
Meridian’s experienced care coordinators:
- Work with members on a plan to meet their health needs and goals
- Help members understand their coverage and benefits
- Connect members with community resources
- Advocate for members and their families
To refer a member to BH care coordination:
- Contact Provider Services at 866-606-3700 (TTY: 711), Monday – Friday, 8 a.m. – 5 p.m.
- From the main menu, select option 7 to reach a BH specialist and refer a member to BH care management
- Submit a BH case management referral through the secure provider portal
Illinois BH providers should be familiar with the Illinois Medicaid Comprehensive Assessment of Needs and Strengths (IM+CANS), a required screening HFS uses to determine eligibility for Medicaid Community Behavioral Health Services.
All providers who use the IM+CANS tool must complete required training and receive annual certification. HFS partners with the Provider Assistance and Training Hub (PATH) at the University of Illinois at Urbana-Champaign to provide training and technical assistance to providers in the use of the IM+CANS.
Additional IM+CANS Resources
Find fact sheets and tools below to support coordinated, evidence-based BH care.
BH Utilization Management
Tools and information to assist with BH service requests
Consult the table below for BH service authorization and notification requirements. Utilize the Prior Auth Check Tool for code-specific requirements.
Mental Health Services | |
Notification required within 48 hours (Effective 1/1/26, notification is required within 48 hours of admission. If notification requirements are met, concurrent review will not be initiated for the first 72 hours of admission.) |
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Notification required within 24 hours (Effective 1/1/26, notification is required within 24 hours of initiation of services. Concurrent review may begin after the 24-hour notification period.) |
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Prior authorization required |
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No prior authorization required |
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Substance Use Disorder Services | |
Notification required within 24 hours (Effective 1/1/26, notification is required within 24 hours of initiation of services. Concurrent review may begin after the 24-hour notification period.) |
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- Review our Service Authorization Program page for details about authorization procedures and policies
- Determine PA requirements using our online Prior Auth Check Tool
- Submit PA requests electronically using Availity Essentials or the Meridian secure provider portal
- Submit PA requests via fax:
BH utilization management and care coordination teams are available to support discharge planning efforts and transitions between levels of care. Discharge planning should begin at the time of admission.
- Within 24 hours of discharge from care, providers should submit their discharge summary to Meridian with the following core components:
- Scheduled appointment with a BH specialist within seven (7) days of discharge
- Scheduled follow-up appointment with member’s PCP
- List of prescribed medications
- Alternatively, providers may complete and submit the Behavioral Health Discharge Transition of Care Form (PDF), which includes the core components needed to support effective care coordination.
Additional Resources
Find tools below to assist with the transition of care process.
Review the document below for answers to commonly asked BH provider questions about Meridian’s service authorization programs.
Children and Youth
Program information, resources, and support for pediatric BH providers
The Pathways to Success program is available for Medicaid-enrolled children under the age of 21 in Illinois who have complex BH needs and could benefit from intensive home and community-based services. These services may involve:
- Family peer support
- Intensive home-based therapy
- Respite
- Therapeutic mentoring
- Therapeutic support services
- Personal support services
The Department of Healthcare and Family Services (HFS) uses a BH Decision Support Model to help identify youth who might benefit from the Pathways to Success program. Providers who believe their patient may be eligible for the program can also submit a request for eligibility determination. Visit the HFS Pathways to Success web page for additional details.
All members under the age of 21 who are experiencing a mental health crisis may be supported by Meridian’s Mobile Crisis Response program. If you believe a child is experiencing a mental health crisis, contact the CARES line at 1-800-345-9049. All Medicaid health plans in Illinois utilize the CARES line for the purposes of centralized intake and localized dispatch for children in mental health crisis.
After a call to the CARES line, a Meridian BH care coordinator will follow up with the member’s providers to ensure proper follow-up treatment and care coordination.
The Family Leadership Council (FLC) is an opportunity for members to provide feedback to Meridian regarding children’s BH and special care needs. Along with Meridian BH staff, this group consists of youth, parents, and community partners.
Providers, help refer members and parents to the FLC, which provides members with a chance to:
- Connect with other youth and families
- Learn about helpful community resources and events
- Share lived experiences
- Communicate opportunities to improve behavioral health services
- Discuss improvements to services for children with special needs
FLC meetings are held quarterly, and members can receive a $50 prepaid debit card for their participation. Our Member Events page includes upcoming FLC meetings and links where members can register. Providers with questions or interest in learning more can contact FLC leaders at FamilyLeadership@mhplan.com.
Launched in 2025 as part of the Illinois Children’s Behavioral Health Transformation Initiative, BEACON is an online portal designed to help Illinois families connect to BH resources. It streamlines the process of finding and accessing BH services to help ensure that every child in Illinois can receive the support they need.
Visit the Illinois Department of Human Services’ BEACON web page for providers to learn more about the tool and how to use it.
BH Programs for All Populations
Evidence-based approaches to support member outcomes
FEP is a case management program designed to help members who have experienced their first episode of psychosis. Research confirms that early detection and treatment of psychosis enable individuals to achieve better long-term health outcomes and decrease the likelihood of future episodes.
Visit the state’s FEP web page to learn more about Illinois’ coordinated network of specialty care programs for individuals who have experienced first-episode psychosis. If you think your patient would benefit from these services, contact Provider Services at 866-606-3700.
Choose Tomorrow is a care management program focused on suicide prevention that is dedicated to strengthening access to care, delivering evidence-based interventions, and harnessing the power of innovative technology to help individuals live their lives to their fullest. Choose Tomorrow leverages advanced data insights and predictive modeling to create individualized member risk profiles, grounded in the latest research in suicidology, behavioral health, and social drivers of health.
Review the Choose Tomorrow Impact Brief (PDF) to learn more. If you think your patient would benefit from these services, contact Provider Services at 866-606-3700. For behavioral health crises, call the CARES line at 1-800-345-9049.
The PiC program employs a data-driven approach to strengthen provider collaborations and optimize patient outcomes of providers whose utilization patterns are 2-3 standard deviations above the norm compared to peers with similar demographics and specialties. By analyzing member clinical data, PiC identifies opportunities for improvement and facilitates targeted interventions to enhance behavioral health service delivery.
Individual outreach is conducted to engage providers who are identified for participation in the PiC program.
The Members Empowered to Succeed (METS) Program is an integrated, whole-health approach to support Meridian members with significant BH challenges—and the providers who care for them. METS focuses on the individual needs of each member to create a personalized recovery roadmap.
Individual outreach is conducted to engage providers who are identified for participation in the METS program. Learn more below:
Substance Use Disorder
Programming to support members in their journey to recovery
HALO is a case management program created for members at risk of developing a substance use or opioid use disorder (SUD/OUD). HALO leverages a machine-learning predictive model to provide early identification of members at risk of SUD, including alcohol, amphetamines, opioids, and other substances that are on the rise. In addition to helping identify high-risk members, the data helps determine which interventions and program outreaches will be most impactful for each individual member.
Through case management, a plan of care is developed with the member and providers to address SUD-specific needs and interventions tailored to maintain recovery. Review the HALO Impact Brief (PDF) to learn more. If you think your patient would benefit from these services, contact Provider Services at 866-606-3700.
Quality Improvement
Reference tools to support care gap closure
Our Quality Improvement team maintains a comprehensive HEDIS Quick Reference Guide to support providers in their work to deliver high-quality, preventive care and improve HEDIS rates. In addition to HEDIS measure descriptions, the guide notes billing and diagnostic codes that may be used to capture performance.
Access the current guide from our HEDIS Guidelines and P4P page. It includes a dedicated section for BH-related HEDIS measures, and approved BH screening instruments are noted in the appendix.
Review our flyer with BH-specific HEDIS measure changes (PDF) implemented in 2025.
Provider Education
Learning opportunities for BH providers
Meridian, through our parent company Centene, offers free BH trainings to providers via live, instructor-led webinars. Trainings are available on a variety of clinical topics, and some are eligible for continuing education credits.
- Review our Behavioral Health Training Catalog to find available courses and register.
- Visit the Provider Education page for additional training opportunities, such as Mental Health First Aid and training tailored to foster/adoptive caregivers.
In addition to new provider orientations for all products, we offer special orientations for Community Mental Health Center (CMHC) and Substance Use Prevention & Recovery (SUPR) providers. See the calendar and register on our Upcoming Webinars page.