Behavioral Health – Employee health plan

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Notification

Notification is required within 48 hours of admission for urgent/emergent acute inpatient or detoxification services, or whenever it is medically feasible (which is longer). Acute inpatient and detoxification services 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

To request prior authorization or notify Medica of an urgent/emergent admission:

Submit information through the health plan Provider Portal or Availity Essentials per member benefit plan
Call member services at the phone number on the back of the patient's member id card
Fax 1-608-252-0830 or email us the completed mental health authorization form

All services

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

For inpatient services, please provide the following:

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 WHENEVER IT IS MEDICALLY FEASIBLE (WHICHEVER IS LONGER).