The Contract Provider Service Authorization is based on the Individual Treatment and Rehabilitation Plan (ITRP) and specifies the level and type of services that will be authorized.
The Contract Provider Service Authorization contains the:
- Case manager's name
- Client's name
- Client's BJCBH identification number
- Services authorized and date
- Client's co-payment (if applicable)
- Rate for each service
For changes to the authorization, contact the case manager indicated. Authorizations are mailed upon the initial referral for your services. Cancellations are mailed monthly.
Authorization for Individual and Group Psychotherapy
Physicians must contact a client's case manager to request authorization for a client referral for individual or group psychotherapy. Clinical rationale and clearly defined treatment goals need to be identified. The case manager obtains supervisory approval, initiates the referral and amends the ITRP. Individual psychotherapy is authorized for weekly hour sessions (CPT Code 90806/4 units), not to exceed three months. Physicians may not refer a client to receive psychotherapy within the BJCBH provider network without seeking prior approval. BJCBH will not reimburse for psychotherapy without prior approval.
Group psychotherapy's treatment efficacy is documented and has demonstrated "goodness of fit" for BJCBH clients. If clients accessing group psychotherapy make progress towards their treatment goal(s) and are compliant with scheduled meeting times, group psychotherapy may be re-authorized for an extended period. Group psychotherapy is usually authorized for weekly 90-minute sessions (CPT Code 90847/6 units).
Crises can be minimized with assertive, proactive treatment and case management. Crisis intervention services may help prevent hospitalization or assist a client with an emergency. The BJCBH staff or contract provider with immediate client contact should assume a lead role in resolving the crisis and share information with other staff. This person should communicate any changes to staff involved in care and involve others in resolution strategies. The contract physician and BJCBH staff should be involved, if hospitalization is considered.
Contract providers should inform the case manager of the number of units used by the next business day and a CMS 1500 should be submitted. BJCBH staff will then review and authorize the services units for payment.