Acute Inpatient Psychiatric Treatment Facilities
Effective July 1, 2019, acute inpatient psychiatric services were added to the Select Health contract as covered benefits for First Choice plan members.
This benefit covers services provided in a free-standing psychiatric facility for members under 21 years of age.
Select Health will adopt the guidelines as outlined in the South Carolina Department of Health and Human Services (SCDHHS) Psychiatric Hospital Services Provider Manual, revised 07/01/19.
For providers offering these services, the following applies:
Prior authorization is required for all admissions. Requests may be submitted via:
- Phone: Contact Behavioral Health Utilization Management at 1-866-341-8765.
- Fax: Complete the Behavioral Health Inpatient Fax Request Form located on the Select Health website and fax to 1-888-796-5521.
- Online: Through NaviNet, at navinet.navimedix.com/sign-in. Go to prior authorization management.
A SCDHHS Certification of Need (CON) for Psychiatric Hospital Services for Children Under 21 Form must be completed for all members under age 21 admitted for acute inpatient treatment services in a free-standing psychiatric hospital.
Claims will be submitted on the UB04 claim form and will be reimbursed as follows:
- Department of Mental Health (DMH) free-standing psychiatric hospitals will be reimbursed based on the prospective payment system.
- All other free-standing psychiatric hospitals will be reimbursed based on the DRG reimbursement system.
- The $25 inpatient admission copay will apply for members over the age of 18 who are not part of a federally recognized Indian tribe and/or pregnant.
For additional information or general questions, contact your Provider Network account executive or the Provider Contact Center at 1-800-575-0418.
For prior authorization questions, contact Behavioral Health Utilization Management at 1-866-341-8765.