Pre-authorization

All health plans administered by Mesa Mental Health require pre-authorization for outpatient mental health and substance abuse services.

In most situations, a member will call MMH first to either obtain their authorization or to obtain recommendations for providers appropriate to their needs.

If an authorization is generated, a copy will be sent to the provider's office within 24 hours. This will provide you the verification that the member has already called us. If the member arrives at your office without an authorization your office may call us directly to generate one.

Members in the HMO no longer need a referral from their primary care physician to ontain mental health or substance abuse services.

All initial authorizations for therapy are for ten(10) visits.

Ongoing authorizations

If you find that you will need more than the ten visits initially authorized please fill out an Outpatient Treatment Request and mail or fax (505-816-6702) to MMH. Upon review of the documentation up to twenty(20) more sessions per OTR may be approved.

If you are a physician you will need to request more medication management visits (90862) only once. The subsequent approval will be for as many visits as needed to treat the member. This applies only for visits billed as a 90862. Any other visits will need to have their own authorization and will follow the general authorization procedures.

Exceptions

The following services require a separate pre-authorization for reimbursement:

• Sessions greater than 50 minutes(90808, 90809 etc.)
• Psychological or Neuropsychological testing
• Frequency of sessions greater than once a week or more than one per day