Partners’ Utilization Management Department has separate referral processes for:
Alcohol and Drug Abuse Treatment Centers (ADATC)
Partners’ Utilization Management has a referral process and forms for Alcohol and Drug Abuse Treatment Center (ADATC) services. Providers should follow the ADATC Referral Procedure.
The following documents are required for all ADATC referrals and need to be faxed to the attention of the ADATC Utilization Management Care Manager at 704-884-2701.
If you have questions, please contact the Mental Health and Substance Use Utilization Management Unit at 1-877-864-1454.
Electro Convulsant Therapy (ECT)
Electro Convulsant Therapy is managed the Partners Utilization Management (UM) Department. ECT Service Authorization Requests (SARs) will be reviewed by UM Medical Doctors.
ECT Limits and Documentation Requirements
Adult ECT: 901, 90870
Adult Initial ECT: Up to Six (6) Unmanaged ECT sessions, per fiscal year. Providers must submit a Notification SAR.
Inpatient ECT SARs should match and not exceed the authorized dates for Inpatient Psychiatric services. Outpatient providers should submit a notification for (unmanaged sessions) or a SAR (for managed sessions) up to Six (6) units/sessions in a Six (6)-day timeframe.
Adult Continued ECT: Prior authorization is required before the Seventh (7th) or more sessions. Inpatient and Outpatient Providers can request up to three units/sessions in a five-day timeframe. Inpatient ECT SARs should match and not exceed the authorized dates for Inpatient Psychiatric services. Inpatient and Outpatient Providers must provide the information requested on the Electroconvulsive Therapy (ECT) Continuation Form.
Adult Maintenance ECT: Prior authorization is required before the Seventh (7th) or more sessions. Outpatient Providers can request one unit/session in a one-month timeframe.
The “Six (6) Unmanaged ECT sessions, per fiscal year” include sessions given in an Inpatient setting, Outpatient setting, or combination of both.
Child ECT: 901HA, 90870HA
Child Initial ECT: No Unmanaged ECT sessions. Prior authorization is required before the First (1st) session. Inpatient and Outpatient Providers can request up to three units/sessions in a five-day timeframe. Inpatient ECT SARs should match and not exceed the authorized dates for Inpatient Psychiatric services. Inpatient and Outpatient Providers must provide the information requested on the Electroconvulsive Therapy (ECT) Continuation Form.
Child Continued ECT: Prior authorization is required. Inpatient and Outpatient Providers can request up to three units/sessions in a five-day timeframe. Inpatient ECT SARs should match and not exceed the authorized dates for Inpatient Psychiatric services. Inpatient and Outpatient Providers must provide the information requested on the Electroconvulsive Therapy (ECT) Continuation Form.
Child Maintenance ECT: No Unmanaged ECT sessions. Prior authorization is required. Outpatient Providers can request one unit/session in a one-month timeframe.
Psychological Testing Guidelines
Partners recognizes the importance and value of psychological testing to address specific diagnostic questions necessary for an individual’s treatment that cannot be answered through the diagnostic interview and psychiatric evaluation.
Psychological testing is the use of formal procedures employing reliable and valid instruments to measure intellectual, cognitive, emotional and behavioral functioning. Psychological testing may be used to identify intelligence, psychopathology, personality style, interpersonal processes, and adaptive skills. Neuropsychological testing is a specialized area of psychological testing that can identify the presence of brain damage, injury or dysfunction, and associated functional deficits. Before conducting psychological testing, it is important to obtain current clinical information through a Comprehensive Clinical Assessment and/or Psychiatric Evaluation. It is also important to inquire about additional psychological testing that may have been conducted with the individual, and obtain copies of such evaluations before conducting psychological testing. Before referring for or administering psychological testing, it is important to answer the following questions:
1. What clinical information about the individual is already available?
Available clinical information should be reviewed before conducting psychological testing.
2. What questions will be addressed by psychological testing?
Specific questions to be addressed should be identified before referring for psychological testing.
3. Can these questions be addressed through diagnostic interviewing, including a psychiatric evaluation?
Most information needed for the treatment of mental health and substance use disorders can be obtained as well or better through skillful diagnostic interviewing. However, some issues such as intellectual functioning, adaptive functioning, and the presence of possible thought disorders may be better identified and understood through formal psychological testing.
Psychological Testing is not covered in the following situations:
- Testing conducted primarily for educational purposes, including for cognitive abilities, learning disabilities and academic achievement. Testing for qualifying for services that are covered under applicable State or Federal Special Educational laws.
- Vocational referrals, including the need for Vocational Rehabilitation services, job placement, vocational interests, and aptitudes, or fitness for duty.
- Legal referrals from attorneys in preparation for criminal or civil court proceedings. Court-ordered evaluations that would not be otherwise considered medically necessary under these guidelines. (Note: Multidisciplinary Evaluations to determine the need for guardianship and Forensic Evaluations to determine competence to participate in legal proceedings have alternative referral and funding mechanisms through the LME-MCO )
- Requests for information about parenting skills or the capacity to parent from the Department of Social Services or courts
- Testing for the routine diagnosis of Attention Deficit/Hyperactivity Disorder (ADHD). Suspected ADHD can be diagnosed or ruled out in most situations through careful diagnostic interviewing and gathering of information from collateral resources such as parents and teachers. ADHD questionnaires are often useful in obtaining such input and do not require psychologists to administer.
- Testing for basic screens or other self-report inventories that are normally completed as part of a comprehensive clinical evaluation
- Testing conducted primarily for the titration of medication
- Repeated testing on a routine or periodic basis that does not otherwise meet the requirements of these guidelines. An exception is repeated intellectual and adaptive testing for minors with previously identified intellectual or developmental disabilities in order to determine continued eligibility for IDD treatment services every three years.
Directions for Requesting Prior Authorization for Psychological Testing:
- Assure that the individual has had a recent Comprehensive Clinical Assessment and/or Psychiatric Evaluation. Exception: individuals believed to have an intellectual or developmental disability that need to qualify to receive IDD services may be referred to intellectual ability and adaptive functioning before completion of a Comprehensive Clinical Assessment.
- Inquire about, obtain and review prior Psychological Test Reports and other relevant clinical assessments, treatment summaries, etc.
- Identify whether and how Psychological Testing will enhance and facilitate the individual’s treatment.
- Complete and submit a service authorization request (SAR) and the Partners Psychological Test Authorization Request Form [Psychological Testing Form] to Partners 10 or more days before the proposed test date(s).
- Follow directions on the form to submit to Partners for review.
- To ensure coverage, request and obtain authorization before performing testing. Psychological Testing can be conducted under Medicaid enrollees’ Unmanaged Outpatient Basic Benefit. Psychological Testing must have prior authorization once unmanaged basic benefits are exhausted to determine medical necessity as defined in this guideline, and is subject to post service review.