| Referral Required for Behavioral Health Referrals for Healthy Families | Close | ||||||||||
Healthy Families Members with need for behavioral health evaluation or treatment should be referred on their first visit to a program contracted with Healthy Families through the State of California to assess if the problem is a Serious Emotional Disturbance (SED). If it is determined that the problem meets diagnostic and severity criteria for SED, outpatient behavioral health coverage is provided through the State. If not, it is covered by the Health Plan of San Joaquin (HPSJ). In San Joaquin County, the State contracted program is San Joaquin County Behavioral Health. In Stanislaus County, the contracted program is the Stanislaus Behavioral Health and Recovery Center, and in Merced County, the contracted program is Merced County Department of Mental Health. Providers in these programs will evaluate the patient and either continue to care for them or refer them back to a HPSJ contracted mental health provider depending on the diagnosis and severity of the problem. Physicians that choose to refer a Healthy Families patient for an initial behavioral health evaluation to a behavioral health provider other than those listed above must complete an authorization request. An authorization request may be completed on the Doctors Referral Express (DRE) New Request form. Under Auth type, choose consultation (Healthy Families Behavioral Health) or for follow up visits choose office visit (Health Families Behavioral Health). If an evaluation is needed promptly, please contact us at (209) 942-6340 and HPSJ will involve a case management nurse to expedite the visit. If you do not have access to our DRE provider portal to submit your referrals and authorizations, please call Provider Services and obtain your secure access today. We can also come out to your practice to train your staff on all options available through DRE. Please address any questions or concerns to Provider Services at (209) 942-6340. |
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