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Intensive Outpatient Programs (IOP)
and Partial Hospitalization Programs (PHP)

An IOP is a planned, structured, service provision of at least two hours per day and three days per week (totaling at least nine hours per week) addressing a mental or substance-related disorder. A (PHP) is intensive outpatient treatment for less than 24 hours a day, but at least four hours a day, three days a week, designed to provide patients an individualized and attentive treatment program. PHPs are for people suffering with serious mental illnesses, eating disorders and/or substance abuse problems that require treatment not normally provided in a regular outpatient setting. Read More

Clinical Screening Tools

Research indicates providers don"t always identify patients in need of mental-health services when the providers rely only on clinical impressions. Screening tools should not be used to make a diagnosisabout behavioral, mental, or health problems. These tools are meant to help members and providers identify risk and when further medical treatment might be necessary. Read more

Clinical Guidelines and Best Practice

Blue Cross of Idaho has adopted clinical practice guidelines from professional societies and other recognized sources, including the American Psychiatric Association, the American Academy of Pediatrics and the National Institute of Alcohol Abuse and Alcoholism. Our Care Management staff uses these guidelines to help members and their providers make decisions about the appropriate treatment for common behavioral disorders. These guidelines are based on scientific, evidence-based research. Read more

Blue Cross of Idaho has included Best Practice resources to help providers meet documentation expectations, measure treatment outcomes, and assess behavioral problem areas.Read more

Level of Care Criteria

Blue Cross of Idaho uses objective guidelines to make medical necessity decisions. We base level of care guidelines on sound clinical evidence and apply them based on individual need and the available of services in the treatment area.

Prior Authorization Process / Forms

Obtaining prior authorization for these services ensures they are medically necessary and cost effective. Services requiring prior authorization are listed in the member contract and the PAP902 Behavioral Health Prior Authorization Requirements.

The following two documents were developed to assist you in completing the prior authorization forms. Each section includes information as to "Why?" the information is being requested and "What?" exactly is being requested.

Additional Services Request-Extended Care Instructions -This document is designed to assist you, the provider, in completing the Additional Services Request-Extended Care form-answer none if there are none.Read more

Psychological/Neurological Testing Request Instructions - This document is designed to assist you, the provider, in completing the Psychological/Neurological Testing Request form. Please do not leave any section blank or unanswered on the Psychological/Neurological Testing Request form-answer none if there are none.Read more


Depression Management

Like diabetes and heart disease, depression is a serious medical illness that is quite common. Depression is one of the most prevalent mental health conditions in the United States, affecting approximately 19 million American adults each year. Depression affects about 5-8 percent of the United States" adult population in any 12-month period. In fact, depression ranks as the largest cause of disability in the developed world and the fourth-largest cause of disability in the developing world.

The symptoms of depression vary widely and may greatly impact the social and economic well-being of sufferers. Psychological, biological, environmental and genetic factors contribute to its development. Depression is disruptive in many ways, such as causing people to withdraw from their relationships, from their work and from the very fabric of society. To make matters worse, researchers believe that more than one-half of people who succeed in committing suicide were suffering from depression at the time.

Of all the mental illnesses, depression is among the most responsive to treatment. Although depression can be a devastating illness, it is highly treatable. Most people diagnosed with serious depression can be effectively treated and can return to their routine daily activities and experience relief from their feelings of depression. There are three well-established types of treatment for depression: medications, psychotherapy and electroconvulsive therapy (ECT).

The primary focus of the Depression Management Program (DMP) is to improve the quality of life for our members with depression (DSM-IV codes: 309.00, 296.2x, 296.3x, 300.4 and 311) by advocating for the proper screening, diagnosis, treatment and management.Read more 

Complex Care Management

Complex care management is a supplemental program designed to support the provider/patient relationship and plan of care. Licensed case managers encourage patients to follow their providers" recommended treatment plans, monitor patient progress, and communicate with patients to ensure they are receiving treatment that will lead to superior clinical outcomes.Read more

Residential / Inpatient
Electroconvulsive Therapy (ECT)

Residential-treatment is 24-hour a day care outside of a hospital. This is usually licensed at a residential intermediate level or an intermediate care facility. 24-hour levels of care are the most intensive levels of care for treatment of mental illness and/or substance abuse disorders.

Outpatient extended care
Neuropsychological and Psychological Testing

Therapy services typically provided in an outpatient office setting. These services may include but are not limited to an initial diagnostic interview, individual and group psychotherapy, psychological and neuropsychological testing and medication management. Read more

Click a section on the map to find more information.

Behavioral health management focuses on improving the quality of life for people suffering from mental health or substance abuse issues (MHSA) and is a key aspect of a person’s overall health and wellbeing.

Our Behavioral Health Management Department is an integral part of Blue Cross of Idaho’s Medical and Quality Management division. Having a department dedicated to MHSA issues allows us to help coordinate our members’ overall care, providing a well-integrated approach to their entire health picture rather than segregating behavioral health from other aspects of their care.

Get your Behavioral Health Management brochure here. pdf download

Learn about Mental Health Parity and what it means to you.