Provider Update: Behavioral Health Authorization Requirement Changes
Date: 01/08/19
This update applies to contracted, fee-for-service Oregon Health Plan behavioral health providers.
Trillium Community Health Plan (Trillium) is implementing changes to the prior authorization (PA) requirements for Oregon Health Plan (OHP) for behavioral health services. Changes will go into effect February 1, 2019. These changes are outlined below in the Authorization Requirements table.
***Please note, this is a revision of the December 28, 2018 provider update. PA requirements changes outlined below apply only to Trillium OHP.***
ADDITIONAL INFORMATION
Prior Authorization look-up tools and additional provider resources can be accessed by going to the Provider Resources section on our website: www.trilliumohp.com. A prior authorization is required for all non-par services.
Trillium will offer provider overview sessions in January 2019 to contracted, fee-for-service behavioral health providers. To RSVP for a provider session, please visit https://www.lanecounty.org/government/county_departments/health_and_human_services/trillium_behavioral_health/provider_information. If you have questions regarding the information contained in this update, contact Trillium Community Health Plan at 1-877-600-5472 or 541-485-2155 and ask to speak with the Behavioral Health Department.
PRIOR AUTHORIZATION REQUIREMENTS CHANGES
The table below indicates key changes to prior authorization requirements for Trillium fee-for-service billing for behavioral health services with participating providers, effective February 1, 2019. Utilization counts will be based on calendar year, with 2019 utilization counts beginning on February 1, 2019. Authorization requirements apply to all services billed for behavioral health conditions including mental health and substance use disorders.
In addition to existing requirements, additional authorizations requirements will be applied to the following services:
| Service(s) | Code(s) | Comment |
|---|---|---|
Addition: Outpatient Therapy/Counseling | 90832, 90833, 90834, 90836, 90837, 90838, 90846, 90847, 90849, 90853, T1006 | - Contingent authorization required upon exhaustion of 25 combined units (i.e. any combination of codes listed within Outpatient Therapy/Counseling group) - Utilization count is per member, per calendar year with 2019 counts to begin 2/1/2019 - Applies to mental health and substance use disorder treatment - Medicaid/OHP |
Addition: Outpatient Services | H0004, H0005, H0006, H0036, H0038, H2014, H2027, H2032, T1016 | - Contingent authorization required upon exhaustion of 120 combined units (i.e. any combination of codes listed within Outpatient Services group) - Utilization count is per member, per calendar year with 2019 counts to begin 2/1/2019 - Applies to mental health and substance use disorder treatment - Medicaid/OHP |
Addition: Intensive Outpatient Program | H0015 | - Prior authorization from first date of service for all behavioral health programs and conditions - Medicaid/OHP |
Change: Partial Hospitalization Program | H0035 | - Prior authorization required from first date of service for all behavioral health programs and conditions - Medicaid/OHP |
Change: Residential Treatment | H0018, H0019 | - Prior authorization required from first date of service for all behavioral health programs and conditions - Medicaid/OHP |