Provider Administrative Policy
Mental Health Physician
DisclaimerOur provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an effcient 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.
Patients who require the most intensive level of care (i.e. inpatient with a primary diagnosis of mental illness or substance abuse) typically are most at risk for recurring pathology due to the severity of the diagnosis that required hospitalization. To reduce this risk, it is important to monitor and facilitate their access to follow-up care. Blue Cross of Idaho expects that a patient discharged from inpatient psychiatric or substance abuse level of care is in urgent need of outpatient follow-up. The patient should visit an outpatient mental health provider no more than seven calendar days following discharge. Blue Cross of Idaho monitors ambulatory follow-up after hospitalization for mental illness and reports the rate as an Effectiveness and Care measure for HEDIS.
Severe mental illness is debilitating. Untreated, mental illness can lead to further crisis and deterioration. Effective treatment, especially appropriate discharge plans for patients hospitalized for mental illness and/or substance abuse, is an effective way to reduce future crises and re-hospitalizations. Discharge plans that only discharge to a halfway house, state hospital, or outpatient psychotherapy are not adequate aftercare plans since these plans only specify a place and not a treatment. An appropriate aftercare plan should include a discharge destination, treating professional and confirmed appointment in addition to specific information regarding the patient’s treatment regimen such as medications, psychotherapy, etc.
The following are specific requirements when planning discharge aftercare:
- Appointments should be available to accommodate patients being discharged needing follow-up within seven days
- Insure that follow-up treatment takes into consideration treatment planning that occurred as a result of an inpatient confinement
- Upon admission to a level of care, the facility will begin discharge planning with the member
- Discharge plan to include:
- Discharge destination (i.e., home, IOP, outpatient, etc.)
- Treating professional’s name, address and phone number
- Confirmed appointment date and time
- Specific information regarding the patient’s treatment regimen (i.e., medications, psychotherapy, etc.)
- Documentation showing discharge plan was faxed to the aftercare provider (i.e., fax cover sheet)
By working together and coordinating care between facilities and professionals, the result is improved quality of care for your patients – our members.
Please contact the Provider Contact Center or your provider relations representative for details (See PAP100).
|September 2009||New||Mental Health Parity|