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PAP901

Federal Employee Plan (FEP) Enhanced Mental Health Benefits


Provider Administrative Policy

Section
Behavioral Health
Policy Date
July 2007
Status/Date
Revised/January 2011
Provider Type(s)
All Providers  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

Federal Employee Plan (FEP) Enhanced Mental Health Benefits

FEP members' personal identification cards have a 24-hour toll-free telephone number enabling them to call for referrals to preferred providers, facilities, or for more information about enhanced benefits. We only refer members to preferred providers contracting in a plan's corresponding directory and will not refer members to non-preferred providers. All providers who have a mental health provider contract with Blue Cross of Idaho are considered preferred providers by the federal government. 

Benefits

Inpatient Prior Authorization:

Prior authorization is required for all inpatient stays; members failing to get prior authorization may incur financial penalties.

To maximize benefits, Preferred providers should:

  • Obtain prior authorization for inpatient hospital services.

FEP members should:

  • Obtain care from a Blue Cross of Idaho contracting (preferred) provider.
  • Follow an approved treatment plan.

When a covered family member seeks care from a preferred provider for a covered service, he or she may save money. If a member seeks care from a non-preferred provider, the coinsurance will be higher. For more information about FEP mental health benefits see PAP100.


OUTPATIENT MENTAL HEALTH AND SUBSTANCE ABUSE (MHSA) CARE

Although individual, group, intensive outpatient programs and partial hospitalization programs no longer require prior authorization, Blue Cross of Idaho may review treatment plans for medical necessity and/or case management for members who:
  • exceed 15 individual or group therapy visits; and/or
  • exceed six or more intensive outpatient program visits; and/or
  • exceed five or more partial hospitalization visits.

 Basic Option  Enrollment Codes   Standard option  Enrollment Codes
  • 111 Self Only
  • 112 Self and Family
  • 104 Self Only
  • 105 Self and Family

FEP members' service benefit plan provides benefits for outpatient mental health and substance abuse care rendered by professional providers who have a mental health provider contract with Blue Cross of Idaho.

It is important for your patients to contact the behavioral health hotline listed on their ID card before scheduling an appointment. This hotline helps patients find preferred providers and:

  • Ensures the patient's MHSA provider has a preferred status
  • Includes new preferred providers not yet listed in the directory
  • Helps members understand what type of provider best suits their needs
  • Answers all member questions.

FEP members in the following counties have limited access, or do not have access, to preferred mental health providers:

  • Boise
  • Butte
  • Cassia
  • Clark
  • Custer
  • Owyhee

Members may contact Blue Cross of Idaho for the most current information regarding preferred providers.

Case Management Services
Blue Cross of Idaho may provide professional case management to assist in assessing, planning and facilitating treatment options and care for eligible members with chronic and/or complex conditions. For more information about Blue Cross of Idaho's case management process, advise members to contact us at the telephone number listed on the back of their ID card.

Emergencies
Members experiencing a mental health emergency should seek the appropriate medical care immediately. If hospitalized, a member must arrange for a prior authorization within 48 hours (see PAP100 for contact numbers).


Policy History

Date Action Reason
January 2011 Revised New changes for 2011
April 2010 Revised Prior authorization language added
January 2010 Revised Removed BPA information
September 2009 Moved Moved from 703 (FEP) to 901 (Behavioral Health)
March 2009 Revised New changes for 2009

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