TMPPM 2010 > Behavioral Health, Rehabilitation, and Case Management Services Handbook > Physician, Psychologist, and Licensed Psychological Associate (LPA) Providers > Psychiatric Services for Hospitals > Prior Authorization Requirements

7.16.1 Prior Authorization Requirements

Prior authorization is not required for fee-for-service clients admitted to psychiatric units in acute care hospitals. Prior authorization is required for Primary Care Case Management (PCCM) clients admitted to acute care hospitals. Urgent or emergent admissions for inpatient PCCM psychiatric services require retrospective prior authorization. Out-of-network admissions require notification within the next business day and submission of clinical information to determine appropriateness for transfer to a contracted facility.

For clients 20 years of age or younger, initial admission to a state psychiatric facility or freestanding psychiatric facility may be prior authorized through CCIP for a maximum of five days based on Medicaid eligibility and documentation of medical necessity. Court-ordered services are not subject to the five day admission limitation.

Note: NorthSTAR is a managed care program in the Dallas service area that covers behavioral health services. Psychiatrists who provide behavioral health services to clients in NorthSTAR must be members of the NorthSTAR BHO.

Refer to: Subsection 3.11.3, "Prior Authorization and Documentation Requirements" in the Children's Services Handbook (Vol. 2 Provider Handbooks) for more information about inpatient psychiatric services.

Section 8: Managed Care (Vol. 1, General Information) for more information, or contact the client's BHO.

Providers rendering services to STAR and STAR+PLUS clients must contact the respective managed care plan.