Most behavioral health treatment is provided by primary care providers (PCPs). It may be difficult for PCPs to thoroughly assess a patient’s mental health and substance use issues and concerns. That’s why we’ve created this toolkit: To help PCPs and members find the resources they need.
Behavioral health affects a person’s overall well-being, and when undetected and untreated, it often worsens. Untreated or inappropriately treated behavioral health concerns can:
- Negatively impact a person’s quality of life
- Interfere with proper management of co-occurring medical treatment
Lead to increased utilization of the health care system, including frequent and often lengthy primary care visits
Timely access to behavioral health care is critical to patients’ overall well-being. Telehealth appointments can help meet that need.
PCPs: If your patient needs a referral for behavioral health evaluation or treatment, you can recommend they check whether the following providers are in their network.
For facilities: To improve our members’ outcomes and to reduce or avoid readmissions, it is important that patients are seen by a behavioral health provider within seven days of discharge from an inpatient or residential facility. We encourage you to share the following telehealth options with your patients to help them receive needed post-discharge care. Note: Discharge appointments do not count as follow up appointments.
Care management services (utilization and case management)
We encourage integration of behavioral health providers into primary care homes and reimburse behavioral health services provided in the primary care setting. Read the Collaborative Care Codes (Behavioral Health #100) reimbursement policy in our Reimbursement Policy Manual.
Treating comorbid behavioral health and medical conditions is essential for patient safety. It is our expectation that providers share diagnostic assessments and treatment plans with other professionals treating the patient, including interventions, therapies and medications. Most behavioral health information can be shared among treating providers—even those in different organizations—without a release of information (ROI) for the purposes of coordinating care. Requesting an ROI before coordinating care can delay appropriate care and can lead to poor outcomes. Exception: ROIs are required for coordinating with substance use disorder (SUD) providers or facilities.
Use our Authorization to Disclose Protected Health Information forms to obtain patient consent when coordinating with a SUD provider:
- Authorization to Disclose Protected Health Information (PDF)
- Authorization to Disclose Protected Health Information, Spanish (PDF)
Authorization to Disclose Protected Health Information - Medicare members (PDF)
Get started with these resources from Healthwise.