We are dedicated supporting our providers.

We believe that compassion and consideration is of utmost importance.

Provider Information

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].

Member Eligibility

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].

Provider Information

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.

Providers have the ability to request case management and complex case management services for their members through the Provider Portal or over the phone.

eferral 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].

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

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

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].

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.

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.

Call Logs

QC Portal can show the user up-to-date electronic medical records through the call log system.

Claim History and Submission

QC Portal additionally allows for viewing claim history and submission of manually entered claims and 837 EDI files.

Member Eligibility

QC Portal uses real-time data to search and preview member eligibility.

Referral History

QC Portal allows for searching for outpatient mental health service records.

Authorization History

QC Portal also can display authorization history, including inpatient, partial, and intensive outpatient mental health service records.