Welcome to Human Behavior Institute's online provider services. At HBI we realize the demands placed on you in dealing with the challenging mental health care system, so we developed this section with you in mind. As an HBI Network Provider, you can access essential information and resources to help you in your practice, including:
Contact HBI’s Provider Services Department at credentialing@hbinetwork.com or submit a completed Letter of Intent with all the necessary supporting documents by fax to (702) 248-9640.
Each of the above steps must be satisfied before proceeding to the next. Qualified applicants with clean records usually take about 60 business days to process.
If you would like to enroll into the HBI Provider Network, please contact HBI’s Provider Services Department at credentialing@hbinetwork.com or submit a completed Letter of Intent with all the necessary supporting documents by fax to (702) 248-9640.
HBI does not make credentialing or re-credentialing determinations based on a provider’s race, ethnic/national identity, gender, age, sexual orientation, or the types of services (e.g. Medicaid) in which the provider specializes. Practitioners are selected using the following criteria:
HBI Network serves members of several insurance plans and each plan design is unique. When you were admitted into the HBI Network, you received a welcome letter and a copy of the agreement with the insurance plans you are contracted with. It is your responsibility as a provider to understand the terms and conditions in regards to eligibilities, authorization, and claim submission, specific to each plan. A copy of the current Contracted Plan Summary Guide can be requested by e-mailing claims@hbinetwork.com.
Whether it’s fee-for-service or managed care plans, HBI adheres to the Medicaid Services Manual – Chapter 400 in rendering services to Medicaid recipients. Medicaid plans have separate guidelines for provider eligibilities and enrollment. To verify if you are eligible to render services to Medicaid recipients as an HBI provider, please contact our Provider Service at credentialing@hbinetwork.com.
Centralized scheduling enables HBI’s Intake Department to match members with the appropriate clinician on the initial call. Members can call HBI (Toll-free) 1-800-441-4483 and speak to an Intake Specialist who will obtain and determine the patient’s:
In any of the cases above, the initial evaluation session is automatically authorized, verification of eligibility is already done for you by our Intake Department and tagged with our UM Department as referred patients. However, there may be a lag of time before you actually see the patient and changes in their benefits may have occurred. Therefore, providers must always check the patient’s eligibility and benefits prior to their appointment.
Although not specifically required by some commercial and even the public sector health plans, HBI advocates for a more holistic treatment approach for all the members/patients we serve. We have observed that a significant number of recipients requesting psychiatric medication but not psychotherapy treatment. We live in a society where drugs, whether prescribed or not, seem to be preferred as remedy in order to deal with life’s daily challenges (i.e., emotional, behavioral) but the underlying problems still remain.
HBI is committed to helping our patients to gain better understanding of their behavioral health benefits by providing a “therapeutic community” – involving providers, family support, school teachers and community agencies. We urge our network providers to be a part of this therapeutic community by utilizing care coordination services through Treatment Referrals.
In case the therapist/counselor does not have a specific psychiatrist to refer the patient to, HBI can make the referral based on the patient’s preference (i.e. geographic location, language, etc.) and coordinate the referral with the patient.
Some plans have a pre-approved number of initial sessions and some require prior authorization from the initial visit. You must verify eligibility before seeing your patient. With some plans, the initial evaluation is automatically authorized. Refer to your copy of the Contracted Plan Summary on verifying eligibility and benefits.
Providers must submit the appropriate report in order to obtain authorization for continued services. Certain plans require that authorization be issued within a specific number of days. For example, Medicaid requires that authorization be issued within 14 days of receiving the request and all required information. HBI’s turnaround time for processing properly completed requests for authorization is usually within 24 hours upon receipt.
As the name implies, this form is used to record your patient’s initial evaluation report. It must be completed and submitted to HBI in order to register the member’s visit and to request for follow-up sessions.
If you believe that your client’s problems and symptoms indicate (SED) Severe Emotional Disturbance (for children and adolescents, age below 18) or (SMI) Severe Mental Illness (for adults), complete the SED/SMI Determination forms and submit it with the mental health assessment.
If you have been treating a particular member of an extended period of time and you believe that this member has a diagnosis with corresponding symptoms that need to be addressed further with additional services, you as a network provider must submit a completed Outpatient Extended Care report before additional visits can be authorized. This type of request must meet eligibility and UM Criteria.
Some plans allow specific network providers to request and administer a psychological or neuropsychological testing. This service is subject to medical necessity criteria and requires prior authorization. Testing may be considered medically necessary only if used to satisfy all of the following:
For neuropsychological testing, a medical diagnosis or clinical symptom presentation suggesting a medical diagnosis is required in order to approve testing.
You or your patient may contact HBI in order to register the patient’s information prior to the initial visit. If you’ve already seen the patient for the initial evaluation, we ask that you submit a completed short one-page Psychiatric Initial Evaluation.
If you have exhausted the authorized number of visits for your patient and need to render additional sessions, submit a completed Medication Follow-up Report.
For more information on obtaining prior authorization, contact:
HBI Utilization Management
E-mail: um@hbinetwork.com
Fax: (702) 248-0079
HBI’s Utilization Management (UM) Criteria are developed and approved by the Quality Improvement Committee consisting of highly-experienced clinicians, psychiatrists, psychologists, and plan representatives, and are based on established national standards from:
When a requested service does not meet the UM criteria, then the case is referred to HBI’s Clinical Director and/or Medical Director for review and a written Notice of Denial is mailed to both the member and provider or facility detailing the reason for the denial and information on the appeal process.
When appealing a denial of service, the provider must contact HBI’s UM Department in writing and provide additional information or documentation to substantiate the reason for more services within a specific time-frame, and request to speak with a peer reviewer.
For more information on obtaining prior authorization, contact:
HBI Utilization Management
E-mail: um@hbinetwork.com
Fax: (702) 248-0079
Consult your copy of the Contracted Plan Summary to determine where you should send your claims for processing based on your client’s insurance plan. To avoid delay of payment, make sure you follow the plan requirements for claims submission.
If a claim is received at HBI and it doesn’t contain all of the information to process the claim, a letter will be sent to you explaining the information required to pay the claim. NO claims will be paid unless all information is documented on the CMS-1500 form.
As a contracted provider, it is your responsible to determine what your patient’s financial obligations are based on their insurance plan.
For more information about claims processing, contact your client’s insurance plan.
HBI believes in an integrated mental healthcare approach. This program, one of the most qualified in the State of Nevada, is comprehensive in nature and is designed to manage and reduce mental healthcare costs without compromising services. HBI offers this integrated mental health concept in a case management format where patients are introduced and guided through the system until they are discharged from treatment.
Care coordination is a continuous process of systematically prioritizing member needs based on defined criteria followed by designing, implementing, and monitoring the most appropriate clinical intervention to achieve a positive outcome.
It is well known that over 50% of all primary care visits involve some level of mental health issues. Antidepressant medication is currently being prescribed at record highs, with over 70% being prescribed by general physicians. Integrating behavioral health with certain medical conditions will accelerate medical recovery, reduce medical costs, give support and consultation services to primary care physicians, and identify those patients who need behavioral health intervention.