- Medicaid BH PA Form - Inpatient (PDF)
- Medicaid BH PA Form - Outpatient (PDF)
- OR Medicaid Certificate of Need Form (CON) (PDF)
For behavioral health services only: Discharge information is required within 24 hours of discharge from IP or RTC levels of care. Please fax discharge clinicals to: 833-505-1300.
Note: Effective July 1, 2021, Prior Authorization requirements for some Behavioral Health (BH) codes have changed.
Codes described below will no longer require Prior Authorization for services when provided by a Participating Provider. Non-Participating Providers still require a Prior Authorization for all services.
Prior Authorization requirements for all codes can be verified on our Pre-Auth Check Tool - Just visit https://www.trilliumohp.com/providers/preauth-check.html.
|Code||Procedure||PA Requirement / Units allowed prior to PA|
|90832, 90833, 90834, 90836 90837, 90838, 90846, 90847, 90849, 90853, H0004, H0005, H0006, H0036, T1006||Behavioral Health Outpatient Therapy||No Prior Authorization is required for Participating Providers. Non-participating providers always require prior authorization.|