Behavioral Health Services
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
View our Medicaid Behavioral Health Provider Manual online or login to your secure Provider Portal at myplan.healthplan.org to access downloadable forms. Our behavioral health preauthorization and review forms, such as crisis encounter, admission review, treatment continuation request, and psychological testing, 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 BHS 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.
Telehealth services will be paid to behavioral health practitioners when face-to-face services are not feasible. InterQual criteria must be met for the service. Services that are eligible for Telehealth include, but are not limited to psychotherapy, pharmacological management, diagnostic interview, and neurobehavioral status exam. For more information on Telehealth services, refer to section 9 of our provider procedural manual.
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 by clicking here.
Guidelines for the Treatment of Depression, Substance Use Disorder, & ADHD
Management of Depression
The Health Plan has adopted the following guidelines for reference in the treatment of depression: "Adult Depression in Primary Care" which is 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.
Substance Use Disorder
For the treatment of substance use disorder, The Health Plan has adopted "Guidelines for the Treatment of Patients with Substance Abuse Disorders" published by The American Psychiatric Association. Click here to access the guideline.
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:
|Behavioral Health Specialist||304.720.4957|
|Referrals and Preauthorizations||1.877.221.9295|