Search
Home
Provider Education Resources
Webinar Power Point Trainings
Video Tutorials
Forms & Downloads
Provider User Guides
Provider Bulletins
Deptartment of Human Services
ADDT/EIDT: Nursing Services
Behavioral Health
DCFS : Foster Care Evaluations
DYS: Alexander Unit
EPSDT: Applied Behavior Analysis (ABA)
EPSDT: Day Habilitative Services
OT/PT/ST
Personal Care
Quality Review Requirements
Inpatient Behavioral Health
Outpatient Behavioral Health
ADDT
EIDT
OT/PT/SLP
Contact Us
Home
Provider Education Resources
Webinar Power Point Trainings
Video Tutorials
Forms & Downloads
Provider User Guides
Provider Bulletins
Deptartment of Human Services
ADDT/EIDT: Nursing Services
Behavioral Health
DCFS : Foster Care Evaluations
DYS: Alexander Unit
EPSDT: Applied Behavior Analysis (ABA)
EPSDT: Day Habilitative Services
OT/PT/ST
Personal Care
Quality Review Requirements
Inpatient Behavioral Health
Outpatient Behavioral Health
ADDT
EIDT
OT/PT/SLP
Contact Us
Outpatient Behavioral Health Requirements
The required documentation for retrospective review must meet the general requirements below and must also meet service specific documentation requirements as indicated in the OBHS manual.
Must be individualized to the beneficiary and specific to the services provided, duplicated notes are not allowed
The date and actual time the services were provided
Original signature, name and credentials of the person, who authorized the services
Original signature, name and credentials of the person, who provided the services, if different from authorizing professional
The setting in which the services were provided. For all settings other than the provider’s enrolled sites, the name and physical address of the place of service must be included
The relationship of the services to the treatment regimen described in the Treatment Plan
Updates describing the patient’s progress
For services that require contact with anyone other than the beneficiary, evidence of conformance with HIPAA regulations, including presence in documentation of Specific Authorizations, is required
Review is based on tier determination per Independent Assessment.
If the claim indicates a crisis intervention, and this is the only service provided to the beneficiary, the mental health diagnosis is not required.
For reviews where no Independent Assessment has been completed, or when an Independent Assessment resulted in a Tier 1 determination, the following documents are required:
Provider note
Mental health diagnosis – must have mental health diagnosis as the first service provided (90791)
PCP referral, if applicable
For reviews where an Independent Assessment was completed with a Tier 2 or Tier 3 determination, the following documents are required:
Provider note
Mental health diagnosis (90791)
Treatment plan covering the claim service date
A Psychiatric Assessment covering the claim service date (90792)