Prepare for the call and make SURE to input all necessary information at the step in the system. Remember, do all work at the steps.
Confirmatory Questions
1. Patient Birthdate?
2. Phone Number?
3. Confirms the NPI?
4. Confirm tax ID?
Medical Information Questions
5. How many hours a week for how many hours a day?
6. Asks to confirm the diagnosis codes
7. Any medical conditions?
8. Pregnant or Postpartum?
9. What brought member into this facility?
10. “Any support at home?”
11. Does member go to school or work?
12. Legal issues?
13. Trauma History?
–Potential follow-up questions about whether or not incidents were reported—
14. Substance Abuse notes?
15. Any family mental illness and psychiatric history?
16. Asks about previous treatment history.
17. MSE upon admission?
18. ADL’s?
19. What medications did member come in with/current/changes and what are the dosages?
20. Member compliant with the meds that we know of?
21. What are the goals while member is there with you?
22. Safety precautions for member at this time?
23. What is the discharge plan?
24. Is the facility communicating with outpatient providers? Who are they?
25. Has member agreed to the current treatment plan?
26. Has member named an outpatient provider?”
– Then they issue the approval
To obtain authorization for behavioral health services, follow these steps:
Check your insurance plan: Before seeking behavioral health services, check your insurance plan to determine if prior authorization is required. Some insurance plans require pre-authorization for certain types of services or for services provided by specific providers.
Choose a provider: Choose a behavioral health provider who is in-network with your insurance plan. If you choose a provider who is out-of-network, your insurance may not cover the cost of the services or may require you to pay a higher out-of-pocket cost.
Contact your insurance company: Contact your insurance company to initiate the authorization process. You may need to provide some basic information, such as your name, insurance plan details, and the type of service you are seeking. The insurance company may also require additional information, such as the provider’s name, the reason for the service, and the expected length of treatment.
Obtain authorization: Once your insurance company has reviewed the request, they will either approve or deny the authorization. If approved, the insurance company will provide you and your provider with an authorization number, which you will need to give to the provider before receiving services. If denied, you may need to appeal the decision or seek alternative services.
It is important to note that the authorization process can take some time, so it is best to start the process as soon as possible to avoid delays in receiving treatment. Also, be sure to follow up with your insurance company and provider to ensure that the authorization has been obtained before scheduling appointments.