Requirements for Submission to PBH |
Published: October, 2001
|
Provider Assessment report (PAR)
Life Status Questionnaire (LSQ) /Youth Life Status Questionnaire (YLSQ)
The Routine Care Model
Health Care Coordination Form Required for All Patients Seen
Individual providers are required to submit the following basic forms to PBH (see Index of Forms for samples):
Provider Assessment Report (PAR): The revised PAR has been reduced in length from two pages to one and has a new feature that facilitates elimination of the PBH Provider Discharge Summary.
- The PAR should continue to be used to request authorization for additional services.
- In addition, the PAR should be used as a discharge summary for brief treatment episodes that are completed with the number of visits initially authorized. The new PAR has a field, "Treatment Terminated." When this is checked and "00" additional sessions are requested, the PAR becomes a Discharge Summary. The PBH Utilization Management Committee determined that sufficient clinical data is already collected with longer episodes of care during the telephonic review process. Therefore, upon completing longer episodes of care, there is no need to submit any form.
The expectation is that PBH will receive one PAR for every episode of care. Prescribing practitioners who provide ongoing medication management (beyond the number of visits authorized by PAR review) have the choice to request authorization for additional sessions each year by submitting a PAR or by calling PBH for a brief telephonic review.
Back to Top
Life Status Questionnaire (LSQ) /Youth Life Status Questionnaire (YLSQ): The Life Status Questionnaire (LSQ) and Youth Life Status Questionnaire (YLSQ) are 30-item assessment tools completed by the patient (or parent). These tools provide information on clinical risk, as well as the patient's overall level of psychological distress. These are preferably faxed to the PBH toll free number - (800) 992-2809. Copies of these forms are sent to practitioners with every authorization.
- The LSQ/YLSQ should be administered at the time of the first, third, and fifth sessions -- they can be used prior to every session if the clinician desires.
- When a patient has multiple providers for medication monitoring and psychotherapy, each provider may utilize the LSQ/YLSQ. However, the expectation is that the psychotherapy provider will always use the LSQ/YLSQ.
- The LSQ/YLSQ should be periodically administered for longer, more complex episodes of care extending beyond the sessions authorized upon PAR review - in other words, please submit an LSQ/YLSQ prior to calling PBH for telephonic review to request additional sessions.
- What about the resistant patient? We would never suggest that you force someone to complete a form when they are firmly opposed, but we usually find that there are two reasons people resist completing them. They often have mistaken ideas about how the form is used, and secondly, they refuse when they perceive that the clinician does not value the process. If you convey that these brief assessment tools can help you track progress together, most people are willing to complete the forms.
In summary, the protocol for submitting clinical information is as follows:
|
Situation |
Information Needed by PBH |
|
Treatment episode requires more visits than authorized initially at time of referral |
Provider Assessment Report (PAR) is faxed to (800) 992-2809.
Y/LSQ completed at first, third and fifth sessions.
|
|
Treatment episode requires more visits than authorized upon PAR review |
Telephonic review with PBH Care Manager for psychotherapy services.
Y/LSQ submitted at time of request for visits beyond those authorized upon PAR review.
Prescribing practitioners have two choices-either submit the PAR each year for ongoing medication management, or if you prefer, call PBH to conduct a brief telephonic review.
|
|
Treatment has been completed with the number of visits initially authorized |
Provider Assessment Report (PAR) is faxed to (800) 992-2809 with a request for "00" additional sessions and the "Treatment Terminated" field completed. |
|
An extended treatment episode has been completed (PBH has already received clinical information via the PAR, Y/LSQ and telephonic review) |
No information needed. |
Back to Top
The forms and requirements for their submission are as follows:
The Routine Care Model
Provider Assessment Report (PAR). In most cases, four sessions are authorized at the time of referral. It is expected that the PAR will be completed and submitted after the second session, and as many as eight additional sessions will be authorized, at the provider's request, for cases of mild to moderate severity. More than eight additional sessions are authorized to complete a treatment episode for more severe and complex cases. (See The Routine Care Model).
Youth/Life Status Questionnaire. Patient reported data at the first, third and fifth visits is required. Should treatment need to be extended beyond the number of visits authorized upon PAR review, an additional Y/LSQ should be submitted at the time of telephonic review. Clinicians may administer the Y/LSQ as often as they find useful for treatment planning or risk management. The Y/LSQ may be requested of the treating clinician as frequently as every five visits beyond the number of sessions authorized upon PAR review.
Back to Top
Health Care Coordination Form Required for All Patients Seen
The Health Care Coordination Form (see Index of Forms) must be completed and mailed to the primary care physician (PCP) for all patients seen. At a minimum, each PCP should be informed when one of his/her patients accesses behavioral health services and be given the patient's diagnosis and basic treatment plan information. This release of information to the PCP requires member consent and the Health Care Coordination Form also serves as a release of information.
Back to Top
  |
