Behavioral Health Program Changes: Updated FAQs Available
As announced, changes are being made to the Blue Cross and Blue Shield of Oklahoma (BCBSOK) Behavioral Health Program effective January 1, 2011. We have updated the previously posted Frequently Asked Questions (FAQs) that review how the upcoming changes may affect you. You can access the updated FAQs in the Clinical Resources section of our website.
Behavioral health care management will be further integrated with our Blue Care Connection® medical care management program. The goal of the integrated Behavioral Health program is to support early identification of members who could benefit from co-management of behavioral health and medical conditions. This service delivery model may result in improved outcomes, enhanced continuity of care, greater clinical efficiencies and reduced costs over time.
Outpatient Preauthorization Requirement Updates
Members may receive authorization for up to 10 outpatient visits per plan year to any behavioral health professional(s) or physician(s) without the need to submit medical records/Outpatient Treatment Request (OTR) forms. However, the member, or the behavioral health professional on the member's behalf, must request preauthorization from BCBSOK before an outpatient service/visit. All claims will be reviewed, and services must be deemed medically necessary as outlined in the member's benefit booklet.
All outpatient behavioral health visits scheduled after the first 10 visits will require that you submit an OTR form. You can call BCBSOK with the required information at any point before the 11th visit using the number on the back of the member's ID card.
These outpatient preauthorization requirements will not be in effect until the member's 2011 group renewal. Members will receive new ID cards prior to their group's 2011 renewal that will include updated instructions for requesting preauthorization, if not currently listed.
We have updated the previously posted FAQs that review how the upcoming changes may affect you. View the updated FAQs .
For program implementation details, watch the online News and Updates section. If you have any questions, please contact your provider network representative.
All behavioral health benefits are subject to the terms and conditions as listed in the member's benefit plan.