Although the responsibility to submit the appropriate documentation
belongs to the provider, it is important for administrative
personnel to understand the process.
Administrative personnel need to have an awareness of the
authorization process and its relation to the billing system
within their offices. Failure to receive proper Pre-Authorization
results in denial of claims.
Individual practitioners are required to submit the following
basic forms to PBH:
The Provider Assessment Report (PAR) should 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 authorized. The PAR has a field, "Treatment
Terminated" which when checked and "00" additional
sessions are requested, the PAR becomes a Discharge Summary.
There is no need to submit any form upon completion of longer
episodes of care, as sufficient clinical data has already
been collected during the telephonic review process.
LSQ/YLSQ
The Health Care Coordination Form needs to be completed
for all members seen and mailed to the primary care physician
(PCP).
Providers requesting authorization for psychological testing
are required to submit the PBH Request for Psychological Testing
Authorizations form to PBH. (See Provider Guidelines, Specialized
Service Procedures section for more information on psychological
testing authorization requests).
You will find sample forms in the Index
of Forms section of this manual.
