Behavioral Health Forms
The following forms are to be used by network providers for the certification of behavioral health outpatient services on all OSU MHCS health plans.
These forms can be mailed or faxed to OSU MHCS. A written verification of the precertification will be returned to the provider within 14 days. The verification will contain the number of sessions authorized as well as the beginning and ending date of the authorization. All authorized sessions must be provided within the identified date span to be covered.
These forms do not apply to inpatient, partial hospitalization, or intensive outpatient programs. These programs require precertification by contacting an OSU MHCS behavioral health case manager by phone.
Referring physicians do not need to submit these forms to the OSU MHCS office. It is the responsibility of the behavioral health provider and the member to ensure precertification is completed.
The referring physician should send a consult form to the behavioral health provider in order to facilitate communication between the treating medical provider and the treating behavioral health provider.
The behavioral health provider should communicate appropriate treatment information to the medical provider in order to facilitate coordination of the patient’s entire health care needs.
- OSU MHCS Initial Authorization
Request
- OSU MHCS Treatment Progress Update
- This form should be submitted for approval of any sessions that exceed
the initial precertified number or any sessions that occur after the
initial date span approved. This form should be submitted prior to the
9th session or the first session after the approved date span if total
number of approved sessions were not used.
- OSU MHCS Psychiatric Medication
Management Record
- This form is for use by psychiatrists who are seeing patients for
only medication monitoring. This can be submitted instead of the Treatment
Progress Update form. (Psychiatrists who are providing counseling must
continue to use the Treatment Progress Update format)
- OSU MHCS Behavioral Health Provider Survey
- Providers are encouraged to update OSU MHCS on their practice demographics and area(s) of expertise/specialty.
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