Virginia Premier Health Plan, Inc.

Behavioral/Mental Health

Behavioral/Mental Health benefits are available to all eligible Virginia Premier Medallion II and FAMIS Members through VPHP’s network of behavioral/mental health providers.

Outpatient counseling and Outpatient Substance Abuse counseling, Medication Management, and Inpatient hospitalization are covered Behavioral/Mental Health benefits when approved by Virginia Premier based on medical necessity.

Outpatient Behavioral/Mental Health Services:

• Members may self-refer to an in-network provider for behavioral health visits.
• Prior authorization requests are not required for the initial 26 outpatient behavioral health/mental health and substance abuse visits when services are rendered by an in-network provider.
• An out-of-network provider must submit clinical information and treatment plan to VPHP Utilization Review staff prior to the first visit.
• Medication Management visits with a participating psychiatrist is provided in addition to outpatient and substance abuse counseling

Inpatient Mental Health Services

Inpatient mental health services are available through VPHP’s network of providers. Elective admissions require prior authorization. In the event of an emergency admission, VPHP must be notified within 24 hours or the next business day. After a member has been hospitalized, we encourage a Behavior Health follow up visit within seven days.

For more detailed information about outpatient and inpatient benefits, refer to the Virginia Premier Provider Manual and/or Member Handbook.

Request for Psychological Testing

Virginia Premier Health Plan views psychological testing as a specialized component of the clinical assessment process. Complete this form to request psychological testing.

A treatment plan must be submitted to VPHP’s Behavioral Health Utilization Review at the time of request. Psychological testing must be pre-authorized for outpatient services.

Outpatient Treatment Report (OTR)

Mental health specialists should contact VPHP’s Behavioral Health Utilization Review to extend visits past those initially authorized and send the Outpatient Treatment Report (OTR) to the appropriate office governing your area (i.e., Richmond, Roanoke, or Tidewater Office). Authorization must be obtained before seeing patients or payment of services may be denied.

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