Behavioral Health Care Management Program
Blue Cross and Blue Shield of Oklahoma (BCBSOK) manages behavioral health services for all non-HMO members who have behavioral health benefits through BCBSOK. For HMO members, behavioral health and substance abuse services are delivered by Magellan Health Services' provider network.
Behavioral health care management is integrated with our medical care management program, as part of Blue Care Connection® (BCC), to help members access their behavioral health benefits and to improve coordination of care between medical and behavioral health providers. This program will help BCBSOK clinical staff identify members who could benefit from co-management earlier, and may result in:
- Improved outcomes
- Enhanced continuity of care
- Greater clinical efficiencies
- Reduced costs over time
Some members* may be referred to other BCC medical care management programs that are designed to help identify and help close potential gaps in care through evidence-based and member-focused approaches to health care and benefit decisions.
All behavioral health benefits are subject to the terms and conditions as listed in the member's benefit plan.
* Members experiencing inpatient hospitalization, complex or special health care needs or who are at risk for medical complications may be referred to BCC programs through a variety of mechanisms such as predictive modeling, claim utilization, inbound calls, self-referrals, and physician referrals. If members do not have BCC as part of their group health plans, they will not be referred to other BCC programs.
Health Care Service Corporation, Inc. (operating through its four division; BCBS of Illinois, BCBS of New Mexico, BCBS of Oklahoma, and BCBS of Texas) Behavioral Health Care Management program was accredited for Health Utilization Management in October of 2012.
URAC, an independent, nonprofit organization, is well-known as a leader in promoting health care quality through its accreditation and certification programs. URAC offers a wide range of quality benchmarking programs and services that keep pace with the rapid changes in the health care system, and provide a symbol of excellence for organizations to validate their commitment to quality and accountability. Through its broad-based governance structure and an inclusive standards development process, URAC strives to ensure that all stakeholders are represented in establishing meaningful quality measures for the entire health care industry. For more information, visit www.urac.org. 
Members are responsible for requesting preauthorization before treatment, when preauthorization is required. Behavioral health providers or a member's family member may request preauthorization on behalf of the member. All services must be medically necessary.
Inpatient and Alternative Levels of Care
Preauthorization is required for all inpatient, residential treatment and partial hospitalization admissions.
- Elective or non-emergency hospital admissions must be preauthorized prior to admission or within two business days of an emergency admission.
- Residential Treatment Center (RTC) benefits are generally excluded from most plans; however, there are some employer groups who have elected to cover this service. To determine if RTC services are covered, call the appropriate number on the back of the member's ID card.
Outpatient
These outpatient services require preauthorization prior to initiation of service:
- Electroconvulsive therapy (ECT)
- Psychological testing
- Neuropsychological testing
- Intensive Outpatient Program (IOP)
Members are responsible for requesting preauthorization when preauthorization is required, although behavioral health providers or a member's family member may request preauthorization on behalf of the member. All services must be medically necessary.
Inpatient and Alternative Levels of Care
- Call the appropriate number on the back of the member's ID card.
Outpatient
(for services requiring preauthorization listed in Preauthorization Requirements)
- Members should call the behavioral health number on the back of their ID card.
- Behavioral health providers or a member’s family member may request preauthorization on behalf of the member.
Inpatient and Alternative Levels of Care
Members who do not request preauthorization for inpatient and alternative levels of care behavioral health treatment may experience the same benefit reductions that apply to inpatient medical services. Medically unnecessary claims will not be reimbursed.
Outpatient
If a member receives any of the outpatient behavioral health services listed below without preauthorization, BCBSOK will request clinical information from the provider for a medical necessity review. The member will also receive notification.
- Electroconvulsive therapy (ECT)
- Psychological testing
- Neuropsychological testing
- Intensive Outpatient Program (IOP)
-
Preauthorization:
Call 800-672-2378 or the preauthorization number listed on the back of the member ID card -
Submit completed Behavioral Health Forms to:
Blue Cross and Blue Shield of Oklahoma BH Unit
PO Box 660239
Dallas, TX 75266-0239
Fax Number: Toll-free 877-361-7660 -
Claims submission address:
Blue Cross and Blue Shield of Oklahoma
PO Box 3283
Tulsa, OK 74102-3283 -
Federal Employee Program (FEP):
877-906-6389
- For preauthorization requirements and other highlights of the Behavioral Health program, view the updated Frequently Asked Questions
- If you have any questions, please contact your provider network representative.
