Mental Health Prior Authorization

Notification

Notification is required within 48 hours of admission for urgent/emergent acute inpatient or detoxification services, or whenever medically feasible (whichever is longer). Acute inpatient and detoxification services may be reviewed for continued stay.

Prior authorization

Prior authorization is required for the following non-urgent/non-emergent mental health services:

• Elective inpatient
• Residential
• Out-of-network outpatient

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

• Submit information through the health plan Provider Portal or Availity Essentials per member benefit plan.
• Call Member Services at the phone number on the back of the patient's member ID card.
• Fax 1-608-252-0830 or email us the completed mental health prior authorization form (PDF).

Mental health education

Our mental health provider education annual training is a series of slides for in-network mental health providers navigating care to individuals enrolled in one of our benefit plans.

• Mental health provider education annual training (PDF)
• ASAM Criteria for patients and families (PDF)

Additional resources:

• Mental health HEDIS measures (PDF)

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

All services:

• Provider tax ID and address
• Member name, birthdate and Dean Health Plan 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

You must notify us of any urgent/emergent inpatient mental health or detox admission within 48 hours of admission or whenever medically feasible (whichever is longer).