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 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 case management is to work members toward improved self-management of their behavioral health and/or medical condition while supporting families with information and other services. This is accomplished by providing information and education about available resources to support the member and family toward recovery, including available clinical services and supports for housing, food, medication, and other social problems. 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
Most outpatient behavioral health services do not require prior authorization for most lines of business for in-network providers. If you have questions regarding necessity for authorization, please call Behavioral Health Customer Service at 1.877.221.9295. The following services typically require authorization:
Mountain Health Trust:
- Crisis stabilization unit after 144 units
- Substance use disorder residential programs after three days
- PHP/IOP after 30 sessions
- Assertive community treatment
- PRTF/acute inpatient mental health treatment
- Peer recovery support services after 90 units per month
Other lines of business may require authorization for additional services which may include but not be limited to:
- Psychological testing
- Applied behavior analysis
- Extended outpatient services
Please check with Customer Service if you are unsure or need assistance.
For assistance with issues of practice management/billing/claims, feel free to contact your designated practice management consultant. Click here for a map of assigned areas and contact information.
Referrals & Prior Authorizations