Behavioral Health Program Information

Behavioral Health Authorization Requirements

A grid that details the outpatient behavioral health authorization requirements for our products.

Outpatient Treatment Notifications

Information on how to obtain and keep track of patient notifications. Details the different methods for obtaining a certification/authorization number, including using the secure provider website and IVR.

It is the treating provider’s responsibility to submit a notification for outpatient behavioral health and substance use disorder services for both initial and additional visits.

Initial Notifications

Providers must submit an initial notification for patients who are new to the practice. If the patient is not new but the previous notification and associated certification number is more than 12 months old and has therefore expired, providers must submit an initial notification.

Notification for Additional Visits

Providers must submit another notification for patients who are continuing with their treatment and have exhausted all visits within the 12 month date range. The member may also submit a request for additional visits.

Submitting Initial and Additional Notifications

Providers can submit notifications for both initial and additional visits by:

  • Logging in to the secure provider website to submit a notification. Refer to the Behavioral Health Self Service User Guide for assistance with submitting initial and additional notifications.
  • Using the Interactive Voice Response (IVR) system by calling 800-208-9565.

Note: Certification numbers can be backdated up to 30 calendar days.

Certification Numbers

Providers will receive a new certification number each time a notification is submitted. If the notification is submitted online, the certification number will begin with a K. If the notification is submitted via the IVR, the certification number will begin with a V. Initial certification numbers given over the phone by a Behavioral Health Coordinator will begin with an R.

Certification numbers are valid for 12 months or until the number of visits are exhausted. This means that visits received as a result of a notification “carry over” into a new calendar or plan year. These visits do not override the member’s benefit limit.

Notifications for Outpatient Therapy and Mental Health Parity

Certification numbers must be obtained for members with Mental Health Parity. Outpatient psychotherapy behavioral health services must be medically necessary. View the Outpatient Psychotherapy Medical Necessity Guidelines.

Psychological and Neuropsychological Testing

Information on psychological and neuropsychological testing requirements including the testing request form:

Inpatient Behavioral Health & Substance Use Disorder

Information specific to the Inpatient Behavioral Health program, including the After-Care Review Form.

Autism/ABA

Resources and information regarding the coverage of Applied Behavioral Analysis and Autism

Tools and Resources

Additional resources including a link to the Provider Search and the Mental Health Newsletter

Please e-mail us your availability at mh_providers@tufts-health.com.

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