Behavioral Health

The WellCare Behavioral Health Integrated Program enables a holistic approach to care in which one integrated care management team is responsible for both medical and behavioral health.

Behavioral Health Forms

Detox and Substance Abuse Rehab Service Request

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Electroconvulsive Therapy Services Request

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Inpatient, Sub-acute and CSU Service Request

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PHP Service Request

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Psychological and Neuropsychological Testing

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Routine Outpatient Services Request

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Illinois Behavioral Health Forms

Covered Services and Authorization Guidelines for CMHC Services

This document includes Harmony and WellCare covered services and authorization guidelines for Community Mental Health Center (CMHC) Services.

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Covered Services and Authorization Guidelines for DASA Services

This document includes Harmony and WellCare covered services and authorization guidelines for Division of Alcoholism and Substance Abuse (DASA) Services.

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IET Engagement Referral Form

Harmony/WellCare IET referral (Engagement Appointment)

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IET Initial Referral Form

Harmony/WellCare IET referral (Initial Appointment)

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Combined Behavioral Health Provider and PCP Communication Form

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Other Resources

Behavioral Health Authorization List

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Frequently Asked Questions

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Provider Orientation

This training course provides a high level overview of WellCare's Behavioral Health program.

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Billing Code Substitution Logic Guide

The table below outlines how procedure & revenue codes are grouped together for the purposes of authorization requirements and claims payment.

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Helpful Documents

Quick Reference Guide

Contains key phone numbers and information on claims, appeals and more.

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IET Provider Incentive Program Description

The 2018 Behavioral Health (BH) Quality Initiation and Engagement in Treatment for Alcohol and Other Drug Dependence (IET) Provider Incentive Program (“BH Quality Incentive Program”) is designed to promote the timely completion of BH services and improve the quality of care for Harmony Health Plan, Inc., (“Plan”) Eligible Members in its Harmony managed care products.

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Guidelines

Case and Disease Management

WellCare offers integrated Case and Disease Management programs specifically designed to assist with behavioral health issues such as depression and diabetes.

Guidelines
Guidelines
- Requesting Higher Level of Care (HLOC) Services
- Submitting Outpatient Service Requests
Case and Disease Management

Case and Disease Management

WellCare offers integrated Case and Disease Management programs specifically designed to assist with behavioral health issues such as depression and diabetes.

Medicare Providers