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Behavioral Health
Behavioral Health

Here you'll find information and tools to support mental health and chemical dependency treatment.

  • About Our Team
    Learn about our Behavioral Health Department.
  • Care Coordination
    Read about our utilization management processes and procedures for mental health and chemical dependency.
  • Case Management
    Learn about our Benefit and Member Management Programs.
  • Clinical Guidelines & Policies
    Keep informed about guidelines and polices pertaining to Behavioral Health care.
  • Find a Behavioral Health Provider
    Links to Behavioral Health Providers and Treatment Facilities.
  • Level of Care for Alcohol and Drug Treatment Referral (LOCADTR)

    The New York State Office of Alcoholism and Substance Abuse Services (OASAS) has created an online tool to make recommendations as to the appropriate level of care for individuals in need of substance use disorder treatment based on an individual's risks and resources. The Level of Care for Alcohol and Drug Treatment Referral (LOCADTR) is a clinical tool used with a provider's full assessment. LOCADTR was effective for the Medicaid and Child Health Plus products starting on 7/1/16 and for our Commercial, Federal Employee Program (FEP) and Medicare products effective 9/1/16.

    LOCADTR 3.0 is a web based level of care determination application. NYS OASAS in partnership with The National Center on Addiction and Substance Abuse at Columbia University developed this tool to determine the most appropriate level of care for substance use disorder.

    LOCADTR does not constitute medical advice. Treating practitioners are responsible for the medical advice and for the treatment of their patients. As a result, we recommend that you review these criteria with your doctor to fully understand how the criteria related to your situation.

    For Inpatient Substance Use Reviews including inpatient detoxification, inpatient rehabilitation and residential levels of care; the following questionnaire will be used to document clinical information when determining medical necessity. This questionnaire will be used when the outcome of LOCADTR results in a discrepancy for the level of care being requested by the provider. The questionnaire is to ensure that all pertinent clinical information is documented to make the appropriate medical necessity determination.

    Our plan also has a Behavioral Health Advocate who is available to help you understand a decision, how to ask for an appeal or find a participating provider. To talk to the Behavioral Health Advocate, please call 844-809-7518.

  • Precertifying Behavioral Health Services
    Learn about Precertifying Behavioral Health Services.
  • Provider Manual
    Refer to the Behavioral Health section (Chapter 6) of our provider manuals.
  • Quality Management
    Learn about our Behavioral Health quality management program and policies.
  • Rx Information for Psychiatrists
    Link to information on prescribing and clinical consideration.
  • Specialty Programs
    The Behavioral Health Department has developed several programs to assist in the treatment of members with certain Behavioral Health needs. Due to the nature of these programs, some programs might not be available in all of our Health Plan regions. These programs include:
    • Child and Adolescent Psychiatry Phone Consultation Service
    • First Episode Augmented Treatment (FEAT)
    • Demand Treatment
    • Coordinated Care for the Treatment of Eating Disorders
    • Follow Up Post Hospitalization Program
    • Dedicated Case Management Staff
    • Depression Disease Management
    • Continuity of Care Initiative
  • Tools & Resources
    Here you'll find treatment record templates, screening tools and other resources.