Coming October 1 for BCN behavioral health higher levels of care: Changes in submitting initial authorization requests, concurrent reviews and discharge summaries
Starting Oct. 1, 2016, the requirements for how BCN's behavioral health facilities submit initial authorization requests, concurrent reviews and discharge summaries for inpatient, partial hospital and intensive outpatient services will change. The changes will affect both substance use and mental health cases.
Here's a summary of the changes:
| Type of request | Current practice | Changes effective Oct. 1, 2016 |
|---|---|---|
| Initial authorization | All initial authorization requests are currently submitted by phone. |
When the member is in the emergency department and not yet admitted to a bed, and you need an immediate response to your request, continue to call in your request to BCN at 1-800-482-5982. When the member has already been admitted to a bed, you must submit the initial authorization request through the e-referral system. |
| Concurrent review | Currently, concurrent reviews are submitted using the Behavioral Health IP/PHP/IOP Concurrent Review Form. |
You must submit requests for concurrent reviews through the e-referral system. You'll need to complete a questionnaire within the e-referral system. BCN will no longer accept concurrent review requests submitted by fax. The Behavioral Health IP/PHP/IOP Concurrent Review Form will no longer be available. The questionnaire in the e-referral system will take the place of the form. |
| Discharge summary | Currently, discharge summaries are submitted via fax, using a Microsoft® Word® version the BCN Behavioral Health Discharge Summary form. |
You must complete an Adobe® PDF version of the BCN Behavioral Health Discharge Summary form and attach it to the case in the e-referral system. The PDF form will be available on the BCN Behavioral Health page on this website in late September. |
e-referral User Guide will be updated. Prior to October 1, BCN's Behavioral Health e-referral User Guide will be updated to include instructions for the higher levels of care. Watch for the announcement!
You can refer to the updated User Guide for instructions on how to attach the BCN Behavioral Health Discharge Summary form to the case in the e-referral system. The User Guide will also show you how to complete the questionnaire for a concurrent review.
You can access the User Guide on the Training Tools page of this website.
Sign up to use the e-referral system. BCN-contracted facilities that have not already signed up for access to the e-referral system should apply immediately. Each utilization review user at each facility will need his or her own individual access.
To get access to e-referral, you must register to use the Blue Cross/BCN Provider Secured Services portal. To do that, click to open the Sign Up or Change a User page on this website. Follow the instructions under the heading "To sign up as a new e-referral user."
This applies whether your facility is new to Provider Secured Services or you're already signed up for Provider Secured Services and just need access to the e-referral system.
It is critical that you sign up as soon as possible since granting access takes some time and you'll need access prior to October 1.
Posted: August 2016
Line of business: Blue Care Network