Thursday, March 23, 2017

For Emergencies Call: 911
Crisis Hotline: (951) 686-4357

 

Policies and Procedures

PRE-AUTHORIZATION

•  All visits must be pre-authorized by an EAS/Exclusive Care case manager. Failure to obtain pre-authorization will result in denial of claim payment.

  • •  If you have extenuating circumstances, which prevents you from seeking pre-authorization please notify the EAS case manager within 24 hours from date of service. Your case will be reviewed and a determination made within 14 business days.
  • •  Pre-Authorized visits not used in a calendar year will automatically roll over into the following year. Each authorization is valid one year from the date the authorization was granted.
  • •  We recommend that you check member eligibility at every visit by calling Exclusive Care Member Services at 1(800)962-1133. For online eligibility click here

 

REQUESTING ADDITIONAL SESSIONS

To request additional sessions providers must complete and submit an Outcome Questionnaire (for members 18 and older) and the Outpatient Services Request form (OSR).

What is an Outpatient Service Request form (OSR)?

  • For additional visits, the provider must complete the Outpatient Services Request (OSR), and a scored Outcome Questionnaire (OQ) (from your most recent session).
  • The OSR must be completed in its entirety, if it is not authorization for additional sessions may be delayed until all sections are completed by the provider.
  • The OSR is comprised of the DSM Diagnosis, list of medications and frequency (if applicable), justification for additional sessions, current treatment plan, and number of sessions requesting and CPT code.

What is an Outcome Questionnaire (OQ)?

  • The OQ asks questions which provide you with immediate feedback of your client’s emotional state prior to each session.
  • The OQ measures client’s progress from session to session in the areas of symptom distress, interpersonal relationships and social role. The OQ will also alert you to suicide risk, workplace violence and substance abuse. It takes approximately 10 minutes to complete. Review and score in 5 minutes or less.
  • To administer, provide the OQ to your client before each session.
  • Please fax in the most recent OQ along with the Outpatient Service Request form (OSR).

REFERRAL REQUEST

•  If the provider needs to refer member out to psychiatry, therapy, biofeedback, etc.; they must contact EAS to begin the referral process.

 

SPECIALIZED SERVICES

•  For Psychological Testing requests the provider must contact an EAS case manager to consult on the case to determine if referral for testing is needed. The Exclusive Care plan offers psychological testing for adults and teens starting at 13 years of age.   

 

 

NOTE: To avoid delays please ensure writing is legible and all required fields are completely filled out on the OSR.

County of Riverside