Mental Health and Substance Use Disorder Limits Removed
For charges incurred on or after January 1, 2012, HealthChoice removed limits on the duration of treatment for inpatient and outpatient mental health and substance use disorder treatment. The chart below explains the new benefits:
|Mental Health and
Substance Use Disorder Treatment
Including day treatment and residential treatment
|Certification is required
||Certification is required after 15 visits
Although the limits to the duration of treatment have been removed, providers still need to follow HealthChoice certification procedures as described below:
Inpatient treatment must be certified within three working days of a scheduled hospital admission, or within one working day following an emergency admission. To request certification for an inpatient admission, contact APS Healthcare toll-free at 1-800-848-8121.
Outpatient treatment must be certified for medical necessity when visits exceed 15 per calendar year. To request certification for outpatient treatment, contact the HealthChoice Health Care Management Division at 1-405-717-8879 or toll-free 1-800-543-6044, ext. 8879.
For additional information regarding the certification process, reference the Utilization Review section of the HealthChoice Network Provider Manual which is available on the provider website, or you can contact Network Management/Provider Relations at 1-405-717-8790 or toll-free 1-800-543-6044.