Behavioral Health Providers
National Network of Quality Behavioral Health Providers
Behavioral health professionals and medical facilities that join Carisk’s network enjoy practice-building referrals, coordinated care plans and timely claims processing and payment. Carisk’s network is designed to anticipate, respond to and accommodate Members’ behavioral health needs by incorporating Providers from a variety of disciplines, including:
- Psychiatrists
- Psychologists
- Therapists
- Facilities (inpatient and outpatient)
- Clinical Social Workers
- Behavioral Health Counselors
- Applied Behavioral Counselors
Carisk’s commitment to building and maintaining a quality Provider network involves a multidisciplinary, multi-pronged approach:
- Quality Improvement Program – monitors, manages, evaluates and improves the quality of behavioral healthcare and services
- Annual Medical Record Reviews – ensures Providers’ processes and practices meet privacy and medical record keeping standards
- Accessibility – ensures Members have access to needed services according to Carisk’s standards for outpatient appointments
- Infrastructure – provides a system for coordinated care plans as well as a strong claims processing platform for accurate, timely payment
- Online Portal – provides secure access to treatment records, forms, treatment guidelines and standards, claims processing and more
Utilization Management
Carisk staff may be contacted toll-free at 855.514.5300 during the hours of 8:30 a.m. to 5:00 p.m. Carisk’s clinical staff are available during this time to discuss any questions or concerns related to a UM case or decision. We will also accept collect calls during these hours. Should you need to speak to someone after this time, Carisk also has after-hours physicians available to discuss any questions or concerns related to a UM case or decision. If you require assistance through a bilingual staff member or an interpreter, Carisk can provide language assistance free of charge to the Member. Should you require TDD/TTY services please contact us at 305.514.5399, or toll free at 855.276.7285.
Non-Incentive Statement
In making a decision about authorizing behavioral healthcare, the only factors Carisk considers are whether the care is appropriate and whether coverage exists for the care or service. Carisk never rewards practitioners or other individuals involved in making decisions for denying care or service. There are no financial incentives for any Carisk employee or representative that would encourage underutilization of behavioral health care or services.
What To Do If You Disagree With A Decision
Carisk Behavioral Health uses a team of behavioral healthcare professionals to ensure that Members get the treatment they need and that it is consistent with their health insurance benefits. Occasionally, you may disagree with our decisions. Carisk has an appeals process that can be used if you believe we have not made the correct decision. All appeals are reviewed by psychiatrists or other doctoral level behavioral health clinicians who were not involved in the original decision. In addition to this internal appeals process, you have the right to appeal decisions to an external review body. In the State of Florida, the Agency for Health Care Administration (AHCA) conducts external appeals.
To start an external appeal, you must notify Carisk in writing that you want to appeal a case to AHCA. The written notification must be submitted within thirty (30) days of the date you received notification of Carisk’s internal appeal decision. For additional information about external appeals, contact Carisk’s Compliance Department at 855.541.5300.
How To Contact A Peer Reviewer
If clinical review determination results in a denial, practitioners have the opportunity to discuss this with the Physician Reviewer who rendered the decision. When practitioners are notified of the authorization decision, they are provided with the Carisk telephone number, 855.514.5300 to contact the Physician Reviewer. The Reviewer is available for discussion and/or to receive additional information that may impact the authorization decision. This discussion does not replace or alter the right to appeal the authorization decision.
Medically Necessary Criteria
Carisk has adopted the MCG Behavioral Health Care Guidelines. The purpose of these medical necessity criteria is to guide all of Carisk’s utilization review activities. These criteria are scientifically based and were developed by a nationally recognized advisory panel. These criteria are licensed and protected by copyright laws.
If you would like to request a copy of the MCG Behavioral Health Care Guidelines you must request the specific level of care criteria that you would like to review. The criteria that you request should be relevant to your scope of practice and the level of care that you provide to Carisk enrollees.
Download the request form for MCG Behavioral Health Care Guidelines with Specific Level of Care Criteria.
To request the copy by mail, please mail your request to the following address:
Carisk Partners
Attn: Clinical Operations
10685 North Kendall Drive
Miami, Florida 33176
To request a copy by phone please call 305.514.5300 or 1.855.541.5300.
To request a copy by fax, please send the completed request form to 305.514.5321.
Provider Education Resources
Substance Use Disorder (SUD) affects over 20 million Americans annually, but only 1% receive treatment. Carisk Behavioral Health has developed the Changing Lives program to address the needs of this population.
The purpose of the Changing Lives program is to identify and empower Members who are engaged in alcohol and/or substance abuse to make a positive life change through participation in individualized treatment programs. At all levels of care, Members will be encouraged to take ownership in their recovery and participate in making care plan decisions. From the initial contact, a Carisk Changing Lives Coach/Integrated Care Coordinator will be assigned to the Member. The Carisk Changing Lives Coach will collaborate and coordinate care with a Clinical Care Manager and all treating providers to ensure that the Member’s plan of care addresses his/her individualized treatment goals and incorporates available support systems. The Program is overseen by Carisk’s Medical Director who monitors each case. The overall goals of the Changing Lives Program include coordinating the Member’s general healthcare needs, improving clinical outcomes and achieving total abstinence from alcohol and/or other substances.
Changing Lives PCP Training For Adults
Changing Lives PCP Training For Children and Adolescents
To refer a Member to the program, please download and submit the Changing Lives Referral Form.
Clinical Practice Guidelines
Carisk has adopted eight clinical practice guidelines. These guidelines have all been developed by medical specialty societies. The following six guidelines have been adopted from the American Psychiatric Association:
- Major Depression Disorder in Adults
- Treatment of Patients with Panic Disorder
- Treatment of Patients with Bipolar Disorder
- Treatment of Patients with Substance Abuse Disorders: Alcohol, Cocaine, Opioids
- Assessment and Treatment of Patients with Suicidal Behaviors
- Treating Schizophrenia
Two guidelines related to the treatment of children and adolescents have been adopted from the American Academy of Pediatrics:
PROVIDER PRIVACY AND CONFIDENTIALITY
Join Carisk’s Network
To learn more about joining the Carisk Behavioral Health Provider national network of quality providers, please complete the Provider Interest Form. You may also email your name and the name of your practice, city and state where the practice is located and contact phone number to providers@cariskpartners.com. A Carisk representative will contact you within two business days.
Join Our Growing Network
To learn more about joining the Carisk Behavioral Health Provider national network of quality providers, please complete the Provider Interest Form. You may also email your name and the name of your practice, city and state where the practice is located and contact phone number to providers@cariskpartners.com. A Carisk representative will contact you within two business days.