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Humana Military requires South Region behavioral health care providers to submit Behavioral Health Consult Return reports to primary care managers (PCMs) within 10 working days following the patient’s date of service. (For emergency treatment, you must submit a report within 24 hours.)
Why Are These Reports So Important?
“Primary care managers are the quarterback of the medical team,” explains Dr. Gary Proctor, M.D., Federal Division Chief Medical Officer for ValueOptions. “They need an overview of every aspect of the patient’s treatment to provide the best overall care.”
Proctor concedes that sometimes confidentiality concerns make behavioral health providers hesitant to share information with other physicians. But he emphasizes the many situations in which patients are being medicated by more than one provider. “Full disclosure to a central physician becomes critical to avoid dangerous drug interactions.”
Proctor advises informing patients about the reporting requirement and explaining that the “quarterback” needs to know what’s going on with every provider on the team.
“The PCM—who, of course, is also bound by confidentiality—is not interested in the specific details that might surface in psychotherapy,” he adds. “He or she just needs an overall diagnosis and description of treatment from each player.”
If a patient still balks at disclosure, documentation of the patient’s refusal must be faxed to Humana Military.
What kind of documentation is required?
Behavioral health consult reports should contain information ranging from the beneficiary’s name and identification number to allergies, chief complaint, history of problem, clinical assessment, diagnosis, discharge planning, treatment plan goals and legible provider names and signatures.
A Consult Report Form is available on the Humana Military Web site (click on Provider Resources, then Behavioral Health, then ValueOptions Forms), or the required information can be submitted in a format convenient to the provider.
Learn more information about consult reporting requirements, along with updated fax numbers. |
