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Behavior Health and Substance Abuse Services

PW_002155
Subsections:
Human Behavior Institute (HBI) acts as a facilitator for directing behavioral health and substance abuse patients and managing member care in accordance with the member’s specific needs, location and plan coverage. As the member’s physician, you can refer members to HBI (although a referral isn’t required); mental health care and chemical dependency rehabilitation services require pre-certification. The member or Provider must call HBI toll free at 800-441-4483 to obtain pre-certification or otherwise coordinate those services.  
Please note: HBI doesn’t manage behavioral health and substance abuse rehabilitation services for BlueCard® and national account members. For those members, please refer to the behavioral health/substance abuse phone number on the back of the member’s health plan ID card. 
In emergency situations, please call 911 or direct the member to the nearest emergency facility. HBI is also available to direct you and the member to an appropriate facility or other Provider for emergency services. 
Effective January 1, 2008: 
Anthem’s behavioral health operations acts as a facilitator for directing members to behavioral health and chemical dependency rehabilitation services and managing member care in accordance with the member’s needs, location and health plan coverage. Providers may refer members to Anthem’s behavioral health operations (although a referral isn’t required) at the numbers listed below to locate an in-network Provider for behavioral health and chemical dependency rehabilitation services: 
All local members with alpha prefixes that begin with YF: 866-621-0043
Federal Employee Health Benefit Program (FEP) members: 800-424-4011
 
Please note: Anthem’s behavioral health operations doesn’t manage behavioral health and chemical dependency rehabilitation services for BlueCard® and national account members. For those members, please refer to the behavioral health/substance abuse phone number on the back of the member’s health plan ID card. 
In emergency situations, please call 911 or direct the member to the nearest emergency facility. Anthem’s behavioral health operations will also be available to direct you and the member to an appropriate facility or other Provider for emergency services. 
 
Detoxification
Detoxification services that can be appropriately managed in a behavioral health care substance abuse unit (the majority of all detoxification services) will be transferred to behavioral health care detoxification units and managed by Anthem’s behavioral health operations. Anthem medical management will manage acute detoxification cases that require acute medical beds based on co-morbid medical conditions such as severe cardiac arrhythmia, septicemia, electrolyte imbalance, GI bleeds, liver failure, diabetic coma, etc. 
Utilization Management  
Facility utilization review representatives will transfer detoxification cases to behavioral health care units, and they’ll contact Anthem’s behavioral health operations utilization management department at 866-621-0043 for pre-certification..
For acute medical situations that require admission to an acute medical bed detoxification unit, facility utilization review representatives will continue to call Anthem medical management at 800-336-7767 or 702-228-1277.
Note: FEP utilization management, available toll free at 800-860-2156, will continue to manage detoxification services for all FEP members.
 
Authorizations
For behavioral health services that require authorizations, please see the Quick Reference Pre-certification Guide in the Referrals and Pre-certifications section of this Manual. 
The Individual Authorization Form for Psychotherapy Notes is attached on pages 12.4 and 12.5 for members to authorize Providers to release information as indicated in the form. 
For behavioral health services that require authorizations, please see the Quick Reference Pre-certification Guide in the Referrals and Pre-certifications section of this Manual. 
Psychotherapy Notes Authorization Form

Complete this form for release of psychotherapy notes from Provider to Company. If member wishes to disclose clinical information and psychotherapy notes, member must complete both the Individual Authorization Form and Psychotherapy Notes Authorization Form

 
Individual Authorization Form

Complete this form for release of PHI and clinical information from Provider to Company. If member wishes to disclose clinical information and psychotherapy notes, member must complete both the Individual Authorization Form and Psychotherapy Notes Authorization Form.

 
 
Parity
The following provides a brief summary of parity diagnosis codes for biologically based mental illnesses. 
 
By description
Major depression (single or recurrent episodes)
Bipolar disorders (all type I and type II covered)
Schizoaffective disorders (all types)
Schizophrenia (all specialties/types)
Panic disorder (with or without agoraphobia)
Obsessive-compulsive disorder
 
By specific code
295-295.35
295.5-296.89
300.01
300.21
300.3
 
Depression Pocket Guide 
Depression can affect 10 percent or more of the patients you will see in your office. Because PCPs treat more than 75 percent of depressed patients, we’ve added the pocket guide on the pages at the end of this section to provide you with a helpful tool for identifying depression in our members. These materials are adapted from the Nevada Clinical Guidelines Collaborative and have been endorsed by most major health plans in Nevada. 
Anthem Behavioral Health Contact Information

Product Name Reason for Call Phone Numbers Claims Submission Address Alpha Prefix on Member ID Card
Anthem Blue Cross and Blue Shield  
(local PPO) 
M-F: 8 a.m.-noon, 1- 4:30 p.m. 
Authorization not required for outpatient services 
Customer service 
Claims/eligibility/ benefits 
866-621-0043 
877- 833-5742 
Anthem Blue Cross and Blue Shield Claims 
P.O. Box 5747 
Denver, CO 80217-5747 
PPO local: 
Alpha prefix that begin with YF 
BlueCard®  
(out-of-state PPO) 
M-F: 8 a.m.-noon, 1- 4:30 p.m. 
Authorization not required for outpatient services 
Customer service/  
claims 
Eligibility/benefits: call the phone number on member ID card or: 
888-817-3717 
800-676-BLUE (2583) 
Anthem Blue Cross and Blue Shield Claims 
P.O. Box 5747 
Denver, CO 80217-5747 
PPO: all other alpha prefixes not listed with other products 
HMO Nevada 
M-F: 8 a.m.- 5 p.m. 
Authorization required for first outpatient visit 
Customer service/  
authorization 
Claims/eligibility/ benefits 
 
866-621-0043 
877- 833-5742 
Anthem Blue Cross and Blue Shield Claims 
P.O. Box 5747 
Denver, CO 80217-5747 
HMO: 
YFN, YFY 
FEP -  
M-F: 8 a.m.- 5 p.m. 
- FEP Standard 
Authorization required after eighth outpatient visit  

- FEP Basic

Authorization required for first outpatient visit 
Customer service/  
authorization 
Claims/eligibility/ benefits 
 
800-424-4011 
877-727-4060 
FEHBP 
P.O. Box 36400 
Louisville, KY 40233-6400 
R + 8 numerics 
 
©2005-2014 copyright of Anthem Insurance Companies, Inc.

Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Com pany. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem Web sites constitutes your agreement with our Terms of Use