PROVIDERS
Provider information is maintained on a daily basis by the PsycHealth Provider Relations Department.
If you have any questions about the provider information displayed by QC Portal, please contact the Provider Relations Department at [email protected].
Please note that Member eligibility information is received on a monthly basis from the medical groups. As such, there may be a lag of up to 30 days between the time the medical group makes a change to the member’s policy and when that change is reflected by QC Portal.
If you have any questions about the eligibility information displayed by QC Portal, please contact the Clinical Care Department at [email protected].
All in-network contracted Providers with PsycHealth Care Management, LLC. can view and print their Explanation of Benefit reports directly from the secure PsycHealth QC Portal website. PsycHealth will no longer be mailing these EOBs along with the checks.
Once logged into the portal with your ID and Password, select from the Menu – EOB/Payment History. You will be able to select the EOB by Payment Date. Most recent payments are listed first.
If you are an Out of Network Provider, PsycHealth will continue to mail you your EOBs.
If you have a problem with your ID/Password or any questions regarding this process please send us an email to [email protected]
Providers do not need to wait for mailing of payment to begin posting accounts because EOB are available immediately after printing checks. As a reminder printing checks is on 15th and 30th (31st).
PsycHealth Care Management, LLC. utilizes and maintains explicit medical necessity/clinical review criteria that are:
- based on current clinical principles and practices;
- and developed with involvement form appropriate providers with current knowledge relevant to the criteria under review.
The 2019 screening criteria to be used for all prospective, concurrent, and retrospective review and case management activities are:
- Apollo Managing Behavioral Health 2019 for medical necessity determinations;
- and ASAM Criteria for Substance Use Disorder Determinations third edition, 2013.
Upon request to the Quality Improvement or Clinical Department providers may obtain a copy of any criteria utilized in making a medical necessity determination.
Annually the PsyHealth Peer Review Committee;
- adopts the latest edition of the American Psychiatric Association Practice Guidelines
- Identifies three practice standards for assessment of performance measurements.
- ADHD
- Schizophrenia
- Depression
Providers have the ability to request case management and complex case management services for their members through the Provider Portal or over the phone.
Referral and Authorization requests are reviewed on a daily basis by the PsycHealth Clinical Care Department. The current status of any request can be viewed via QC Portal. All referral and authorization requests will be processed in accordance with terms set forth in the PsycHealth Provider Contract.
If you have any questions about the status displayed by QC Portal, please contact the Utilization Management Department at [email protected].
Claims submissions are reviewed on a bi-weekly basis by the PsycHealth Claims Department. The current status of any claim processed by PsycHealth can be viewed via QC Portal. All claims submissions will be processed in accordance with Illinois law and PsycHealth claim polices and procedures.
If you have any questions about the status displayed by QC Portal, please contact the Claims Department at [email protected].
PsycHealth Care Management, LLC. has ongoing quality programs and initiatives. These are reviewed each year. The reviews let us see what we are doing right or what we can do better. We also look at complaints and satisfaction of our providers and members. For more information, contact PsycHealth at 847-864-4961
From time to time, PsycHealth will use the System Messages to convey important information to providers. Please review the messages on this screen as they may indicate when QC Portal may be unavailable for use due to system maintenance and/or upgrades.
QC Portal is an internet based application and is subject to occasional outages. If the QC Portal website cannot be reached for any reason please contact us so we may resolve the issue. Please note that most outages are resolved within 24-hours.
Self-Determination in Mental Health: The Benefits of a Psychiatric Advance Directive
Advance directives play a significant part to ensure that needed and acceptable treatment and care are provided in a timely manner. The Declaration for Mental Health Treatment (Declaration) is an Advance Directive. The Declaration is often overlooked and rarely discussed unless the patient is in a state of repeat or continual crisis. This is a mistake. Depriving a person of the opportunity to have the knowledge about and choice of such a tool interferes with the ability to exert control over their life and illness. It is time to shake off the stigma concerning a mental health advance directive.
The benefits of a Mental Health Declaration or Advance Directive provide patients with an opportunity to state the type of treatment they prefer. Whether the treatment is psychotropic medications; ECT, hospitalization or any combination of treatments, a clear written statement of the patient’s preferences is made through the Declaration. Once signed, dated and properly witnessed by two witnesses, the Declaration is enforceable in Illinois for three years and will continue in effect until the patient is no longer incapable of making treatment decisions as determined by a physician. The benefits of the Declaration are;
- Ability to make needs/illness known to healthcare providers
- Ability to appoint an attorney-in-fact to act as directed by the Declaration
- Treatment is rendered without multiple provider assessments
- Care is implemented in a timely manner
- Less time spent in the Emergency Room
- Less anxiety for patient and family members
- Increase ability to keep illness under control
- Decrease in critical events that may prolong recovery/stabilization
- Ability to select the agent
Take time to become familiar with the Declaration for Mental Health. There are many patients who will benefit from this tool. Like all Advance Directives, the Declaration is revocable in whole document or in part. In Illinois revocation is effective when it is communicated to the attending physician in writing and signed by the patient. DMHTForm
https://www2.illinois.gov/sites/gac/Forms/Documents/DMHTForm.pdf
Office Telephone: 847-864-4961
24 Hour Telephone:1 800-753-5456
Office Hours: 8:30am – 4:30pm Monday-Friday
E-mail: [email protected]
Administration: [email protected]
Member Services: [email protected]
Provider Services: [email protected]
Claims Department: [email protected]
Utilization/Case Mngmt: [email protected]
QC Portal: [email protected]
The PsycHealth Help Desk for Portal related issues can be contacted via: [email protected]. Please be sure to include your name and telephone number when submitting an inquiry to the Help Desk.
All requests will be addressed within ten (10) business days.