CHRISTUS Health Plan Behavioral Health benefits offer direct access to members. Members can access behavioral health benefits, without a referral from their PCP by calling CHRISTUS Health Plan Medicaid and CHIP Member Services 24 hours a day, 7 days a week at the following hotline (1-877-845-6505).
Behavioral Health providers specific responsibilities
CHRISTUS Health Plan Provider responsibilities include but are not limited to:
- Providing members with access to care within CHRISTUS Health Plan quality standards.
- Emergency: Any situation in which clear and present danger exists for the member, others, or the environment if immediate intervention does not occur. Consistent with appropriate clinical practice, attention will be paid to the ability of the environment to maintain the member safely. Note: CHRISTUS Health Plan follows the “prudent layperson” emergency room standard set forth in the Balanced Budget Act of 1997. Emergencies are further classified as “life-threatening emergency” and “non-life-threatening emergency.”
- For life-threatening emergencies, health care professionals will be requested to offer immediate appointments
- For non-life-threatening emergencies, health care professionals are expected to offer appointments within six hours
- Urgent: A situation in which the member has experienced significant deterioration and/or is experiencing stressors that are contributing to the member’s inability to cope. Unless timely intervention is provided, further deterioration or a crisis is likely to occur. For such cases, health care professionals are expected to offer evaluation appointments and initial treatment within 24 hours.
- Routine: A situation in which the member is not in imminent danger a crisis is not likely to occur before the member is seen. For such cases, health care professionals are expected to offer appointments within 14 days of request.
- Following an inpatient stay, members should be offered an outpatient follow up appointment within 7 days of discharge.
- Verifying member eligibility.
All members have a CHRISTUS Health Plan ID card. Eligibility should be verified prior to rendering services via:
- Utilizing our website at www.christushealthplan.org
- Contacting CHRISTUS Health Plan using the phone numbers listed above.
- Upon arrival for their appointment, providers should verify the CHRISTUS Health Plan ID card, their Medicaid Card or their Form 1027A Medicaid Card (temporary Medicaid ID Card).
- Complying with prior authorization requirements. Members can self-refer to a behavioral health practitioner that is a CHRISTUS Health Plan participating provider. Prior authorization is not required for routine outpatient therapy. Several behavioral health services, however, do require prior authorization.
Behavioral health services requiring pre-authorization
- Inpatient admissions
- Residential Treatment Center (RTC) admissions
- Partial Hospitalization Programs (PHPs)
- Intensive Outpatient Programs (IOPs)
- Psychological testing
- Neuropsychological testing
- Outpatient Electroconvulsive Therapy (ECT)
- Amytal interview
- Psychiatric home care services
- Outpatient Detoxification
- Applied Behavioral Analysis (ABA)
Participating providers are responsible for complying with the prior authorization requirements, policies and procedures and for obtaining a prior authorization number to ensure the payment of claims (see Provider Handbook, Medical Management, and Prior Authorizations). Please note that prior authorization requests for Behavioral Health may be phoned in or faxed in to CHRISTUS Health Plan. The provider fax number for prior authorizations is 1-866-835-9589.