Who submits the notifications?
It is the treating provider’s responsibility to submit the notification for outpatient behavioral health and substance use disorder services.
Initial notifications
Providers must provide an initial notification for patients who are new to the practice. If the patient is not new but the previous notification is more than 12 months old and has therefore expired, providers must submit a new notification. Upon submission of the initial notification, 8 visits will be available.
Notifications for Additional Visits
Providers must submit a notification for patients who are continuing with their treatment and have exhausted all visits within the 12 month date range.The member may also submit a subsequent request. This notification will grant another 8 visits.
Submitting Notifications for Initial and Additional Visits
Providers can submit notifications for both initial and additional visits by:
Note: Notifications can be backdated up to 30 calendar days.
Certification Numbers
Providers will receive a new certification number each time a notification is submitted. The initial letter of the notification number indicates the process by which it was submitted:
- Online: Begins with K
- IVR: Begins with V
- Behavioral Health Coordinator via phone: Begins with R
How long are notifications good for?
Notifications are valid for 12 months from the start date or until the number of visits on the notification are exhausted. This means that visits received as a result of notification “carry over” into a new calendar or plan year. Notifications do not override the member’s benefit limit.
Notifications and Mental Health Parity
Notifications must be obtained for members covered under Mental Health Parity laws. Outpatient behavioral health services must be medically necessary. View the Outpatient Psychotherapy Medical Necessity Guidelines.