REFERRALS AND AUTHORIZATIONS
PsycHealth Care Management, LLC. works with members and providers to coordinate quality outpatient and inpatient services for members.
Our staff strives to ensure that the services our members receive go hand-in-hand with the expertise of the providers delivering those services.
We work with service providers who do not discriminate based on race, religion, gender, sexual orientation, place of residence, national origin, insurance plan, age or physical or mental health status.
Our trained and qualified staff members coordinate services over-the-phone and through our Provider Portal.
The Provider Portal, also known as QC Portal, is a comprehensive managed care software that is highly flexible, easy to use and powerful. The software allows PsycHealth providers to verify eligibility, enter referral and authorization requests, submit claims and view the status of all data in real-time from any internet web browser. If you need access to the portal and you are eligible, contact us to schedule a training.
Referral and Authorization status inquiries can be obtained during normal business hours by calling:
(847) 864-4961
or
(800) 753-5456
All requests for services will be evaluated on the basis of medical necessity and services must be available to the member in accordance with the following accessibility standards:
| Care Type | Definition | Access Standard |
| Life Threatening Emergency | A situation in which a member is at imminent risk for harm to self or others. | Immediately |
| Non-Life Threatening Emergency | A situation where the member is markedly distressed and there is a strong potential for rapid decompensation. | Within 6 hours |
| Urgent | A situation in which a member’s condition could be anticipated to deteriorate to the point of being at risk of harm to self or others if not evaluated or treated. | Within 48 Hours |
| Routine | A request for a referral for members who are presently at no risk for harm to self or others. | 10 Business Days |
Accessibility is the extent to which a member can obtain available services at the time they are needed. This refers to both telephone access as well as the ability to schedule an appointment.
Non-urgent referrals will be provided during normal business hours according to the certificate of benefits established by the member’s health plan.
Emergency services do not require pre-certification. However, under circumstances when the PsycHealth Care Management, LLC. UM staff is contacted, UM staff will provide, arrange for or otherwise facilitate all needed emergency services. PsycHealth Care Management, LLC. will follow the “prudent layperson” standard in making UM decisions related to emergency services. Emergency services are never denied.
Additional visits must be prior authorized by PsycHealth Care Management, LLC. The provider may complete the PsycHealth Care Management, LLC. Outpatient Authorization of Services form (OTR) or submit the request through the Provider portal. Providers can fax in the form or call. PsycHealth Care Management, LLC. requires 5 business days notice to process these requests. A copy of the completed referral will be visible on the Provider Portal. If the request was called or faxed in, we will fax or mail the referral to the provider.
PsycHealth Care Management, LLC works with service providers who do not discriminate based on race, religion, gender, sexual orientation, place of residence, national origin, insurance plan, age or physical or mental health status. We work with providers to ensure that the services our members receive fit with the expertise of the providers.