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. You can also download our treatment continuation request form or contact our office to have one faxed to you. You can also visit our resources page for other 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 behavioralhealthdocuments@healthplan.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. These services are available 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, ext 7301.


Telehealth Services

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. Additional information on Telehealth services can be found in the provider procedural manual (Section 9).


Depression Disease Management

We also offer depression disease management for members diagnosed with Major Depressive Disorder. 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 may do so on the web by clicking here.


Guidelines for the Treatment of Depression, Substance Use Disorder, and ADHD

Management of Depression

  • The Health Plan has adopted the following guidelines for reference in the treatment of depression: "Treatment of Patients with Major Depressive Disorder" which is published by the American Psychiatric Association and can be accessed through the following link: and "Adult Depression in Primary Care" which is published on the National Guideline Clearinghouse site and is the product of the Institute for Clinical Systems Improvement and can be accessed by the following link: guideline.gov. If you have any questions regarding this change, call the Behavioral Health Department at 1.877.221.9295.

Substance Use Disorder

  • The Health Plan has adopted the following guideline for the treatment of substance use disorder. This guideline is: "Guidelines for the Treatment of Patients with Substance Abuse Disorders" published by The American Psychiatric Association. The guideline can be accessed at the following link: substance use guidelines.

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:
    pediatrics.aapublications.org and pediatrics.aapublications.org.

Questions?

Behavioral Health Liaison
304.720.4957

Utilization Review
740.699.6254

Referrals and Pre-authorizations
877.221.9295