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.
- Initial Mental Health Assessment
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.
- Outpatient Extended Care
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.
- Request for Testing
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:
- Diagnose and assess level of cognitive functioning/improvement/assess psychopathology
- Establish/confirm a medical/psychiatric diagnosis,
- Produce a change in the treatment plan
- Guide therapeutic management of the patient
For neuropsychological testing, a medical diagnosis or clinical symptom presentation suggesting a medical diagnosis is required in order to approve testing.
Psychiatrist/MD/DO or Psychiatric Physician’s Assistant
- Psychiatric Initial Evaluation
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.
- Medication Follow-up Report
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
Fax: (702) 248-0079