Program Information


Behavioral Health Services for Children and Adolescents

Coverage is provided for benefits related to children and adolescents up to age 19 with behavioral health disorders that substantially interfere with or substantially limit their functioning and social interactions.

Medical Necessity Guidelines

Payment Policies

Authorization Requirements

Outpatient Treatment Notifications

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:

  •     Logging in to the secure provider website to submit a notification. Refer to the Behavioral Health Self Service User Guide for assistance with submitting notifications.
  •     Using the interactive voice response (IVR) system by calling 800.208.9565.

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.

Tools and Resources

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