Behavior Health and Substance Abuse Services
PW_002155
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. |
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.  | 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 |
| 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. |
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
|
|
|
|
|
|
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
|
| 