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.
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.
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:
- Psychological/Neuropsychological Testing Medical Necessity Guidelines
- Psychological and Neuropsychological Assessment Supplemental Form
Note: Providers can submit the completed form by:
Secure Email: BHPriorAuthCommercial@tufts-health.com
Tufts Health Plan
Behavioral Health Department
705 Mt. Auburn St.
Watertown, MA 02472
Attn: Psychiatric Reviewer
Inpatient Behavioral Health & Substance Use Disorder
Information specific to the Inpatient Behavioral Health program, including the After-Care Review Form.
- After-Care Review Form
- Instructions for Reporting a Discharge
- Transition to Home Referral Request Information
Resources and information regarding the coverage of Applied Behavioral Analysis and Autism
- Autism, ABA and Habilitative Therapy Medical Necessity Guidelines
- Autism Professional Payment Policy
- ABA Initial Services Request—Assessment and Treatment Planning (H0031) ONLY
- ABA Autism Service Request (Initial and Continued)
- Early Intervention ABA Service Request (H2019 only)
Tools and Resources
Additional resources including a link to the Provider Search and the Mental Health Newsletter
- Find a provider
- Payment Policies
- Mental Health Self Service User Guide
- Provider Manuals
- Provider Education
- Mental Health Provider Credentialing Forms
Please e-mail us your availability at email@example.com.