Authorization
M E M O R A N D U M
June 14, 2010
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TO: American Behavioral Network Providers FROM: William J. Howell, MD, Medical Director SUBJECT: New Authorization Procedure |
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Mental health parity became effective for most of the American Behavioral plans beginning January 2010. Since implementation of the law, The Department of Labor has published Interim Final Regulations which will become effective July 1, 2010. This will require some changes in the way outpatient mental health and substance abuse benefits are administered.
The most common outpatient therapy and medication management CPT codes will no longer require precertification/authorization. There are certain outpatient CPT codes, diagnoses and services that will continue to require precertification/authorization. All Employee Assistance Program (EAP) services (billed with V-Codes) require precertification/authorization.
For specific precertification/authorization information, see the following documents:
Managed Behavioral Healthcare Services: Specific Diagnostic Considerations
Managed Behavioral Healthcare Services: Common CPT Codes
Employee Assistance Program (EAP) Services
In addition, our database will flag outliers. When this occurs, clinical information will be required for authorization. You may submit any documentation for consideration in the application of medical necessity criteria and/or schedule a clinician-to-clinician review.
American Behavioral will also conduct random chart audits to assess for any unusual patterns of utilization and will maintain comparative data on providers to evaluate utilization and effectiveness. Please see the following for documentation requirements:
Managed Behavioral Healthcare Services: Documentation Requirements
American Behavioral will continue to manage the benefits with regards to exclusions, exhausted benefits and levels of care. Inpatient, partial hospitalization and intensive outpatient treatment will continue to be precertified at the onset of services.
If you have thoughts or concerns about this new process, please contact the Managed Behavioral Healthcare Services Department at 877-660-6646.
