Behavioral health practitioners will need to obtain authorization from members in order to communicate patient information to the PCP. Once the authorization is on file, the behavioral health provider should communicate, in writing, to the PCP the following information in regard to the member:
- Results of the initial evaluation
- Significant changes in diagnosis, treatment plan, or clinical status
- Medication that has been initiated, discontinued, or significantly altered
- Termination of treatment
You can view Medicaid Behavioral Health information in Section 5 of our Provider Manual here. Our behavioral health prior authorization and review forms, located to the right, can be transmitted electronically via our provider secure web portal. You can reach the Behavioral Health Services at 1.877.221.9295 (24 hours a day) or email firstname.lastname@example.org with any questions. Fax requests for treatment and reporting of crisis encounters to 1.866.616.6255. This is a dedicated fax line that is available to the clinical services staff only.
We offer case management services to members who are diagnosed with behavioral health problems, as well as those who are afflicted with a combination of medical and behavioral health problems. The goal of behavioral health case management is to work members and families toward independence with their behavioral health disease state. This is accomplished by assisting them with education, management of resources, and encouraging them to continue services according to the treatment plan. The case manager addresses not only the symptoms of the illness but also psychosocial problems affecting the member’s everyday life and treatment. This is a telephonic program. If we are unable to reach the member by phone, an introductory letter is sent out to the member so the member has the opportunity to call us back to seek case management services.
If you feel that you have a patient who would benefit from case management services or have any questions concerning behavioral health, please call us at 1.800.624.6961.
Behavioral Health Prior Authorization Changes
As of July 1, 2019 the following behavioral health services require prior authorization:
Inpatient Care Addition
- Residential Adult Services for Substance Use Disorder Waiver: ASAM Level 3.1(H2036U1HF), ASAM Level 3.3(H2036U3HF), ASAM Level 3.5 (H2036U5HF) and ASAM Level 3.7 (H2036U7HF)
Ambulatory Services Addition
- Peer Recovery Support (H0038)
The full Behavioral Health Prior Authorization Requirements list is located here.
Guidelines for the Treatment of Depression & ADHD
Management of Depression
The Health Plan has adopted the following guidelines for reference in the treatment of depression: "Adult Depression in Primary Care" can be accessed on the Institute for Clinical Systems Improvement's website.
If you have any questions regarding this change, call the Behavioral Health Department at 1.877.221.9295.
Guideline for the Diagnosis, Evaluation and Treatment of ADHD in Children and Adolescents
The Health Plan has adopted the American Academy of Pediatrics (AAP) guideline for the diagnosis, evaluation and treatment of ADHD in children and adolescents and the accompanying supplemental appendix. This information can be found on the AAP website at:
Depression Disease Management
For members diagnosed with major depressive disorder, we offer a depression disease management program. If you have a patient who you feel may benefit from the program or if you have any questions about the program, contact the depression disease manager at 1.877.221.9295. If you would like to refer a member to the Depression Disease Management Program, you can fill out an online form.
- ADHD Guidelines (updated 1.30.19)
- Guidelines for the Management of Depression (1.30.19)
- Guidelines for the Treatment of Substance Use Disorders (updated 4.17.18)
|Behavioral Health Specialist||304.720.4957|
Referrals & Prior Authorizations