Mental Health

Hands of two people in a grasp. One set of hands is sandwiching the other.

Notification

Notification is required within 24 hours of admission for urgent/emergent acute inpatient or detoxification services and may be reviewed for continued stay.

Prior Authorization

Prior authorization is required for the following non-urgent/non-emergent mental health services:

Elective inpatient
Residential
Out-of-network outpatient

Request prior authorization or let us know of an urgent or emergent admission

Submit information through the health plan Provider Portal or Availity Essentials per member benefit plan

Fax request to 608-252-0843 or email us ifbhealthmanagement@medica.com using the mental health prior authorization form

Call Member Services at the number on the back of the patient's insurance card

Mental health education

Our mental health provider education annual training is a series of slides for in-network mental health providers navigating care to individuals enrolled in one of our benefit plans.

Mental health provider education annual training

ASAM Criteria for patients and families

Additional resources:

Mental health HEDIS measures

Be prepared to provide the following information (not an inclusive list):

All services

Provider tax ID and address
Member name, birth date and WellFirst Health ID #
Current diagnosis
CPT codes
Medications
Length of authorization
Clinical information supporting level of care being requested

Inpatient services

Admission date
Attending health care provider name
Provider contact name and phone number for concurrent review

YOU MUST NOTIFY US OF ANY URGENT/EMERGENT INPATIENT MENTAL HEALTH OR DETOX ADMISSION WITHIN 48 HOURS OR WHEN MEDICALLY FEASIBLE (WHICHEVER IS LONGER) HOURS OF ADMISSION.