Behavioral Health

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Prior Authorization

WellFirst Health provides all Utilization Management services for the behavioral health needs of our members. A prior authorization is required for the following mental health and substance use services:

Detox
Inpatient
Residential
Partial Hospitalization/Day Treatment
Intensive Outpatient
Out-of-Network Outpatient
In-home therapy

To request a prior authorization or notify WellFirst Health of an urgent/emergent admission:

Submit information through the Provider Portal (if you have access).
Fax request to 608-252-0843 using the behavioral health prior authorization form.
Call our Customer Care Center at 866-514-4194.

Be prepared to provide the following information (not an inclusive list):

All services

Provider tax ID and address
Member name, birthdate and WellFirst Health ID #
Current diagnosis
CPT codes
Medications
Length of authorization
Clinical information supporting level of care being requested

Inpatient services

Admission date
Attending health care provider name
Provider contact name and phone number for concurrent review

Behavioral Health

Prior Authorization

To request a prior authorization or notify WellFirst Health of an urgent/emergent admission:

Be prepared to provide the following information (not an inclusive list):

You must notify us of any urgent/emergent inpatient mental health or detox admission within 24 hours of admission