Substance Use Disorder


For the treatment of substance use disorder, The Health Plan has adopted "Guidelines for the Treatment of Patients with Substance Use Disorders" published by The American Psychiatric Association.


Substance Use Disorder Services:

In July of 2020, most substance use disorder (SUD) services transitioned to managed care, with the exception of Methadone Medication Assisted Treatment. The Health Plan follows ASAM® criteria in determining suitability of a certain level of care for a particular member. This information is included in Chapter 504 of the BMS Provider Manual. You can also read more under Introduction to ASAM Criteria.

 

Residential treatment and larger amounts of peer recovery support services will require authorization. A universal SUD authorization form has been developed and is accepted by all West Virginia managed care organizations reviewing requests from providers for authorization for SUD services for Medicaid members. Completion of this form in its entirety may reduce the amount of requests for additional clinical information to support SUD services for our members.

The new SUD form is available in fillable format here.

 

Use of the new universal form is not mandatory. We will continue to accept the THP specific version of the SUD service request form still in use for other lines of business if Medicaid providers fill it out in error.

 

For assistance or questions, please contact the Customer Services Department at 1.800.624.6961, ext. 7644.

Questions?

Behavioral Health Specialist 304.720.4957
Referrals & Prior Authorizations 1.877.221.9295