Health Care Excel, under the direction of the Ohio Department of Mental Health, performs prior authorizations for Partial Hospitalization (PH) and Community Psychiatric Supportive Treatment (CPST) to evaluate the medical necessity of treatment for both kids and adults who need services beyond the benefit limit.
Ohio-licensed clinical reviewers evaluate prior authorization requests using an established and approved set of medical necessity criteria. When clinical information supports the need for continued services, an approval is rendered. If the clinical information provided does not support the need for additional treatment, the case is deferred to an Ohio-based, board certified psychiatrist for review.
Before a recipient reaches the service limits for either PH or CPST services, a Prior Authorization (PA) for continued services must be obtained.
Health Care Excel staff are available to answer technical and clinical questions about the Prior Authorization Process as well as provide telephonic and on-site education. Please contact Ohio Community Health staff for any questions at 1-888-239-7758 or e-mail OhioCMH@hce.org.
Health Care Excel and Ohio Department of Mental Health Training Power Point Presentations October and November 2011
Additional Resources