Behavioral Health Forms
Changes to Prior Authorization Requirements
OSU Health Plan has made changes to the Prior Authorization requirements for behavioral health providers serving OSU Health Plan members. These changes will positively affect your practice by reducing the number of prior authorizations you need to request, saving you time.
Services No Longer Requiring Prior Authorization
As of Sept. 15, 2009, most office-based services, such as routine outpatient mental health or substance abuse therapy sessions, will no longer require prior authorization to be processed and reimbursed*.
This includes initial assessments, individual, family and/or group counseling sessions of 1 hour or less, medication management sessions and psychological testing. For a complete list of services or CPT codes that no longer require Prior Authorization, click here.
Claims submitted for routine outpatient care by any approved level of licensed provider (psychiatrist, psychologist, PCC, LISW, NP, MFT, LICDC, PC, LSW) will be paid with the appropriate fee schedule/UCR (members owe co-pay or coinsurance) for eligible members when correctly submitted. For non-routine outpatient services that still require Prior Authorization, please use the forms on the bottom of this page.
*OSU Health Plan reserves the right to retrospectively request and review records for clinical necessity and appropriateness of care when there is incongruence between the submitted diagnosis and the amount of services provided.
Services Still Requiring Prior Authorization:
Prior authorization is still required for Inpatient care, residential care, partial hospitalization programs, intensive out-patient programs, ambulatory detoxification services and autism treatment programs. For a complete listing of services or CPT codes that continue to require prior authorization, click here.
Need Help Finding the Right Behavioral Health Provider?
For assistance in finding a behavioral health provider to meet specific demographic needs, specialized treatment modalities or diagnostic disorders expertise, contact our Customer Service Department at (614) 292-4700 or (800) 678-6269.
Need Case Management Assistance?
Sometimes patients have multiple needs beyond what an individual provider can address. They may have a combination of both mental health and substance abuse problems, their major depression can be complicated by a co-morbid medical condition, or they may be anxious and isolating away from others because they are overweight and ashamed to socialize. OSU Health Plan nurse case managers are available to assist our network providers in identifying and coordinating OSU supported or sponsored services. Such services include wellness programs, nutrition services with a registered dietitian, weight loss or smoking cessation benefits and alternative therapies, such as medical massage or acupuncture for patients with pain. Incorporating these resources will help you design the best treatment plan for your patient’s desired outcomes. We also can help you identify a psychiatrist that can be part of the treatment team. If you have a complex client that you would like help with, call (614) 292-4700 or (800) 678-6269.
Submitting Prior Authorization Forms
The following forms are to be used by network providers for the certification of behavioral health outpatient services on all OSU Health Plan medical plans when required. These forms can be faxed to OSU Health Plan at (614) 292-2667, or mailed to:
OSU Health Plan
Attn: Behavioral Health Case Manager
Suite 580
700 Ackerman Road
Columbus, Ohio 43202
A written verification of the Prior Authorization will be returned to the provider within 14 days. The verification will contain the number of sessions authorized as well as the beginning and ending date of the authorization. All authorized sessions must be provided within the identified date span to be covered. These forms do not apply to inpatient, residential care, partial hospitalization, or intensive outpatient programs. These programs require precertification by contacting an OSU Health Plan behavioral health case manager by phone.
Referring physicians do not need to submit these forms to the OSU Health Plan. It is the responsibility of the behavioral health provider and the member to ensure precertification is completed. The referring physician should send a consult form to the behavioral health provider to facilitate communication between the treating medical provider and the treating behavioral health provider.
The behavioral health provider should communicate appropriate treatment information to the medical provider to facilitate coordination of the patient’s entire health care needs.
- OSU Health Plan Initial Authorization Request
- OSU Health Plan Treatment Progress Update
This form should be submitted for approval of any sessions that exceed the initial Prior Authorized number or any sessions that occur after the initial date span approved. - OSU Health Plan Autism Prior Authorization Form
For use by specialty providers treating Autism Spectrum Disorders - OSU Health Plan Autism Treatment Progress Update
- OSU Health Plan Behavioral Health Provider Survey
Providers are encouraged to update OSU Health Plan on their practice demographics and area(s) of expertise/specialty.