Login
Hassle-free Administration.


Login
Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements
View requirements for Local Plan and BlueCard Out-of-Area members.

Enter
Find a Doctor
Search our online provider directory when you need a doctor, hospital or other health care provider.

Behavioral Health Management

PW_AD090913
Effective January 1, 2008, Empire has assumed responsibility for managing behavioral health and substance abuse benefit services for more than two million members, through an internal department. Empire’s behavioral health provider network is open to Psychiatrists, Psychiatric Nurse Practitioners, Psychologists and Licensed Clinical Social Workers who are successfully credentialed through Empire. Member benefits will vary based on Plan and Product, it is recommended that benefits and eligibility are verified prior to treatment commencing, to ensure participation and accurate utilization management rules are applied throughout treatment.  
 
Additional Information
Behavioral Health Follow Up Program (FUAH)
2013 Behavioral Health Medical Necessity Criteria
Outpatient Behavioral Health Pass-Through Visits
Additional Participating Behavioral Health Providers for Empire National Account Members
 

Forms

2013 Outpatient Treatment Report (OTR)

PDF Format

Applied Behavior Analysis (ABA) Treatment Report

PDF Format

Consent to Release Template

PDF Format

Coordination of Care Letter Template

PDF Format

Coordination of Care Form

PDF Format

FEP Outpatient Treatment Report (OTR) Form

PDF Format

Individual Authorization Form

PDF Format

Outpatient Treatment Report

PDF Format

Outpatient Treatment Report – TMS

PDF Format

Provider Profile

PDF Format

Psychological Testing Authorization Form

PDF Format

Psychotherapy Notes Authorization Form

PDF Format

FAQs

Institutional FAQs

PDF Format

Professional FAQs

PDF Format

Quick Guides

Institutional Quick Guide

PDF Format

Professional Quick Guide

PDF Format

 
©2013 Empire BlueCross BlueShield

Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans, serving residents and businesses in the 28 eastern and southeastern counties of New York State. All external sites will open in a new browser window. Please view our Website Privacy Policy for more information.