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Integrated behavioral health

Whole health means focusing on the whole person. So it just makes sense to integrate medical, mental and behavioral health as equal parts on the health care continuum.

Questions?

Check your behavioral health provider manual (PDF) for answers. 

 

Treating a member in crisis? You can call us at 1-855-232-3596 (TTY: 711) 24 hours a day, 7 days a week. Members can call, too.

Whole health is the goal

Whole health is the goal

We help members and their families by making key connections between medical, mental and behavioral health, as well as disability, wellness and prevention. These are the connections that help members take steps toward whole health.

 

Behavioral health includes services provided for the assessment and treatment of mental health and substance use disorders (abuse of alcohol and other drugs). Members at risk of or suffering from mental, addictive or other behavioral disorders have access to services to meet their behavioral health needs.

 

We work with members and providers to focus on prevention and wellness by:

 

  • Screening for issues that could lead to illness and treating them early with a whole-health approach
  • Providing classes and services with providers and others to help members learn to better manage their own care

Behavioral health coverage and fee schedule

Behavioral health coverage and fee schedule

Basic behavioral health

 

These services are provided by medical professionals or behavioral health consultants in medical clinics. Some common services include:

 

  • Screening for common mental health conditions
  • Screening for alcohol or substance use issues
  • Medication management  
  • Coordination of referrals to specialized behavioral health services

Members have access to behavioral health education and resources on the:

 

Licensed mental health or addiction professionals provide these services in a setting that works best for the member and their family’s needs. Outpatient clinics or intensive treatment programs may provide non-emergent services. Some members may also be eligible for home and community-based services. 

 

You can find the billing codes you need for specific behavioral health services in our fee schedule. 

 

Claims for federally qualified health centers (FQHCs) and rural health clinics (RHCs): Be sure to list the provider on claims.

 

Fee schedule (PDF)

Everyone wins with coordination of care

Everyone wins with coordination of care

Working closely with providers to coordinate medical and behavioral care for members ensures appropriate screening, evaluation, treatment and referral for: 

 

  • Physical health
  • Behavioral health or substance use disorders
  • Dual or multiple diagnoses
  • Developmental disabilities

Sharing info for healthier members

Sharing info for healthier members

When medical and behavioral health providers work together, members benefit. Our behavioral health and medical providers share information with that goal in mind. This results in appropriate and effective coordination between medical and behavioral health care.

PCPs screen for behavioral health issues

If you’re a PCP, you’ll want to:

 

  • Use behavioral health screening tools
  • Treat behavioral health issues within your scope of practice 
  • Refer members to behavioral health providers, when appropriate 

Behavioral health providers screen for physical health issues

If you’re a behavioral health provider, you’ll want to:

 

  • Screen members for coexisting medical issues
  • Refer those who have untreated physical health issues to their PCP (with consent)
  • Provide physical health care services only if you’re licensed to do so
  • Share any concerns with their PCP and work together on a care plan (with consent)

Training and resources

Member self-referrals

 

Covered members can self-refer to any mental health/substance use provider in our network without:

 

  • Prior authorization (PA)
  • A referral from their primary care provider (PCP)

 

PCP referrals

 

We promote early intervention and health screening to educate members and find behavioral health problems. To that end, we expect network providers to:

 

  • Screen, evaluate, treat and/or refer (as medically appropriate) any behavioral health problem or disorder
  • Treat mental health and/or substance use disorders within the scope of their practice
  • Tell members how and where to get behavioral health services
  • Adhere to provider standards for member access (PDF) to behavioral health care

Members under age 21 with a diagnosis of autism spectrum disorder have access to ABA services.

 

ABA services focus on the analysis, design, implementation and evaluation of social and other environmental modifications to produce meaningful changes in human behavior. ABA therapy can help:

 

  • Increase language and communication skills 
  • Improve attention, focus, social skills, memory and academics
  • Decrease problem behavior  

 

To provide ABA services, you’ll need to complete an assessment and create a treatment plan. Then, get PA. You can fax the PA form to 1-844-634-1109. Or call us for help at 1-855-242-0802 (TTY: 711).

 

Providers can perform ABA services:

 

  • In their office
  • In a community setting
  • In the member’s home 

When reviewing requests for clinical authorization, our utilization management processes use the most current:

 

 

CPG Audit Questions (PDF)

 

BH PQMP 2022 Complete Scoring Grid (PDF)

 

In the event of a denial, you can ask for a copy of the relevant guideline or criteria. Just call 1-855-242-0802 (TTY: 711).

BH PQMP Complete Scoring Grid (PDF)

 

2022 Person Centered Planning Training (PDF)

 

Spring 2022 BH newsletter (PDF)

 

Behavioral Health Provider Quality Monitoring Scoring Grid (PDF)

 

2022 CCM DOJ Training Flyer (PDF)

 

Behavioral health provider orientation (PDF)

 

Initiation and Engagement of Alcohol and Other Drug Abuse Treatment (IET) (PDF)

 

Telehealth and COVID-19 webinar

 

You can watch the recording of this April 20, 2020 training, which addressed billing and claims questions associated with meeting the demand for enhanced health needs during the COVID-19 emergency. Key highlights included telehealth resources, billing and procedure codes, guidance and requirements.

You’ll need to get PA for new and existing services, including: 

 

  • Community psychiatric support and treatment (CPST)
  • Psychosocial rehabilitation (PSR)
  • Functional family therapy (FFT)
  • Homebuilder services

 

To get PA, fax 1-844-634-1109 with these items:

 

  • PA form: visit our PA page for help 
  • Member choice form (PDF) (for members getting mental health rehabilitation services)
  • Intake assessment
  • Child and adolescent level of care utilization system (CALOCUS)/level of care utilization system (LOCUS)
  • Treatment plan
  • Any other clinical info

You have a 60-day transition period for these requests.

 

You can check the fee schedule (PDF) for a list of services and codes.