Carelon PBHS Provider Manual Version 5 Released, With a New Telehealth Chapter

Carelon released version 5 of the Maryland PBHS Provider Manual on August 21, 2026. Chapters with material changes:

• Chapter 5, Authorizations: retroactive reviews, plus new tips and support materials.
• Chapter 6, Medical Necessity Criteria and Program Descriptions: updated requirements for PRP, Behavioral Health Homes, respite care, 1915(i) intensive services for children and youth, TCM, therapeutic behavioral services, RTC, mobile crisis, gambling IOP and residential, OTP, outpatient mental health, SUD outpatient (ASAM 1.0), residential crisis services, and the inpatient IMD types.
• Chapter 7, Telehealth (new): a dedicated chapter; telehealth references were removed from Chapter 8 (services for participants who are deaf or hard of hearing).
• Chapter 11, Compliance and Provider Audits: recoupment and offset material moved out.
• Chapter 12, Claims Appeals: references modified to align with PBHS procedures.
• Chapter 15, Pharmacy and Transportation: transportation brochure and emergency petition material added.
• Chapter 17, Provider Payments and Financial Information (new): now the home for recoupments and offsets.

What to do

Have your billing lead read chapters 5, 12, and 17, and your clinical director read chapters 6 and 7. If you deliver any service by telehealth, chapter 7 is now the reference your documentation should match.