Behavioral Health Prior Authorization and Utilization Management Training

October/November 2019

Learning Objectives:

• Review Banner Health Plans (BHP) new requirements for providers requesting authorizations and continued stays, including clinical documentation submittals and timelines.
• Understand the requirements for discharge planning and submittal of discharge information for reimbursement.
• Review the new requirements for inpatient facilities to request a retrospective review. 

Training Documents:

• Behavioral Health Prior Authorization/Utilization PowerPoint Presentation
• Pyx Health and Banner Health Plans Presentation
• Behavioral Health Comprehensive Provider Manual Supplement - Securing Services and Prior Authorization/Retrospective Authorization (Updated 11/2019)
• Behavioral Health Comprehensive Provider Manual Supplement - Securing Services and Prior Authorization/Retrospective Authorization: PA Grid (Updated 11/2019)
• Prior Authorization Grid: Behavioral Health
• BHP Contracted Providers (BHRF and BHIF)
• FAQs: Behavioral Health Prior Authorization Process
• BHP Behavioral Health Medical Management Updates for Administrative Denials and Discharge Summaries

Prior Authorization Forms

• Behavioral Health Prior Authorization Form
• Out of Home Admission Notification Form
• Out of Home Application
• Out of Home Concurrent Review Form
• Certification of Need (CON) Form
• Re-certification of Need (RON) Form
• Transfer Request Form

June 2020

Learning Objectives:

• Review Banner Health Plans (BHP) new requirements for providers requesting authorizations and continued stays, including clinical documentation submittals and timelines
• Understand the requirements for discharge planning and submittal of discharge information for reimbursement
• Review the new requirements for inpatient facilities to request a Retrospective Review
• Review the new AHCCCS/ BHP criteria for admission, continued stay and discharge for Therapeutic Foster Care and Adult Behavioral Health Therapeutic Home levels of care

Training Documents

• Behavioral Health Prior Authorization/Utilization Management Training Video
• Behavioral Health Prior Authorization/Utilization Management Training PowerPoint Presentation
• Retro review process can be found HERE.
• Medical Records Requirements for Retrospective Review for Covered Services Form can be found HERE.

Updated Forms

• New Transfer Request
• Out of Home Application
• Out of Home Admission Notification
• Behavioral Health Prior Authorization

September 2020

Training Documents

• BHP Inpatient Forms and Process Provider Training PowerPoint Presentation
• BHP Inpatient Forms and Process Provider Training - Video
• BHP Outpatient Forms Training PowerPoint Presentation
• BHP Outpatient Forms Training - Video

May 2021

• BHP Out of Home Prior Authorization and Continued Care Training Presentation
• BHP OOH Prior Authorization and Continue Care Training Video
• Out of Home Discharge Summary Form
• PYX Health App Flyer (B – UFC/ACC)     English | Español
• PYX Health App Flyer (B – UFC/ALTCS)     English | Español