Behavioral Health – Employee health plan

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Prior Authorization

Medica provides all Utilization Management services for the behavioral health needs of our members. See our Medical Prior Authorization Services List to confirm which behavioral health services require prior authorization.

To request a prior authorization or notify us 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 member services at 877-274-4693.

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

All services

Provider name, tax ID, and address
Member name, birth date and WellFirst Health ID #
Current diagnosis
CPT codes
Medications
Length of service(s)
Clinical information supporting level of care being requested

For inpatient services, please provide the following:

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

YOU MUST NOTIFY US OF ANY URGENT/EMERGENT INPATIENT MENTAL HEALTH OR DETOX ADMISSION WITHIN 48 HOURS OR WHENEVER IT IS MEDICALLY FEASIBLE (WHICHEVER IS LONGER).