Call the line or Submit the DBT Call the line or Submit the DBT IOP CM CM DBT IOP Prior Authorization form to our CM Authorization form along with the Department. required documentation indicated on the form to our CM Department. Approval is for up to 6 months per request. Continuing approval is for up to 6 months per request. Call the line or Submit the Intake Call the line or Submit the BHP Intake CM Outpatient Mental Notification form to our Intake Treatment Plan form to the CM Health Department Department. Initial approval is for up to 26 individual Continuing approval is for up to 26 therapy sessions or 52 group sessions. individual therapy sessions or 52 group sessions. Call the line or Submit the Intake Call the line or Submit the BHP Intake CM Medication Prior Notification form to our Intake Treatment Plan form to the CM Management Department. Department. Initial approval is for up to 24 sessions Continuing approval is for up to 24 over two years. sessions per request. Call the line or Submit the Intake Call the line or Submit the BHP Intake CM Psychological Testing Prior Notification form to our Intake Treatment Plan form to the CM Department. Department. Initial approval is up to 10 hours of ***Please note that in place of goals and testing over 3 months (including the interventions on the treatment plan form, intake and feedback session). include a list of the tests being performed or include a copy of the test report for retro requests. Call the line or Submit the Intake Call the line or Submit the BHP Intake CM Neuropsychological Prior Notification form to our Intake Treatment Plan form to the CM Testing Department. Department. **Note Providers must be either a DHS **Please note that in place of goals and – approved neuropsychologists or submit interventions on the treatment plan form, documentation of neuropsych competency include a list of the tests being performed to BHP. or include a copy of the test report for retro requests.
DBT Call the CM line or Submit the DBT IOP Prior Authorization form to our CM Department. Approval is for up to 6 months per request. Call the CM line or Submit the DBT IOP Authorization form along with the required documentation indicated on the form to our CM Department. Continuing approval is for up to 6 months per request. Outpatient Mental Health Call the Intake line or Submit the Intake Notification form to our Intake Department Initial approval is for up to 26 individual therapy sessions or 52 group sessions. Call the CM line or Submit the BHP Treatment Plan form to the CM Department. Continuing approval is for up to 26 individual therapy sessions or 52 group sessions. Medication Management Call the Intake line or Submit the Intake Prior Notification form to our Intake Department. Initial approval is for up to 24 sessions over two years. Call the CM line or Submit the BHP Treatment Plan form to the CM Department. Continuing approval is for up to 24 sessions per request. Psychological Testing Call the Intake line or Submit the Intake Prior Notification form to our Intake Department. Initial approval is up to 10 hours of testing over 3 months (including the intake and feedback session). Call the CM line or Submit the BHP Treatment Plan form to the CM Department. ***Please note that in place of goals and interventions on the treatment plan form, include a list of the tests being performed or include a copy of the test report for retro requests. Neuropsychological Testing Call the Intake line or Submit the Intake Prior Notification form to our Intake Department. **Note – Providers must be either a DHS approved neuropsychologists or submit documentation of neuropsych competency to BHP. Call the CM line or Submit the BHP Treatment Plan form to the CM Department. **Please note that in place of goals and interventions on the treatment plan form, include a list of the tests being performed or include a copy of the test report for retro requests.
Authorization-Grid.docx