Here are two helpful reminders to follow when submitting requests for authorization, which will ensure proper coverage for your patients and timely reimbursement for your services.

Prior Authorization for Higher Level Care

All nonemergent inpatient behavioral health services require prior authorization. Specifically, Higher Levels Of Care (HLOC) require prior authorization, such as Partial Hospitalization Programs (PHP) or Residential Treatment Center (RTC) programs.

While these types of treatment may be recommended, they are not considered an emergent level of care and may require a few days to obtain prior authorization. ValueOptions generally processes nonemergent authorization requests for HLOC within two business days. All requests are processed within five business days following receipt of the request and all required information.

When ValueOptions receives your Outpatient Treatment Report (OTR), a clinician reviews and approves units based on medical necessity. If units are approved, an autofax is sent to your office notifying you of the number of units approved and an expiration date for the services.

ValueOptions has noticed an increase in OTR requests when an adequate number of unused units are still available. It is important to remember to thoroughly read the information that is autofaxed to you regarding your authorizations for continued care and note this information in the patient’s chart. This will prevent unnecessary paperwork for your office and ValueOptions.

For more information regarding authorizations for behavioral health care, please call ValueOptions at 1-800-700-8646.
 

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