Behavioral Health Services
Referring Participants for behavioral health services
Participants may self-refer for behavioral health services. However, primary care providers (PCPs) and other physical health care providers often need to recommend that a Participant access behavioral health services. The health care provider or their staff can find assistance for Participants needing behavioral health services by calling the toll-free numbers noted on the Pennsylvania Behavioral Health Managed Care Map listed on this page.
Cooperation between network providers and the behavioral health managed care organizations (BH-MCO) is essential to help ensure Participants get appropriate and effective care.
Behavioral health and substance use services — by county
Requirements when working with BH-MCOs
Network Providers are required to:
- Adhere to state and federal confidentiality guidelines for Participant medical records. This includes obtaining any required written Participant consents to disclose confidential mental health and drug and alcohol records.
- Refer Participants to the appropriate BH-MCO, once a mental health or drug and alcohol problem is suspected or diagnosed.
- To the extent permitted by law, participate in the appropriate sharing of necessary clinical information with the behavioral health provider. This includes, if requested, all prescriptions the Participant is taking.
- Be available to the behavioral health provider on a timely basis for consultation.
- Participate in the coordination of care when appropriate.
- Make referrals for social, vocational, educational, and human services when a need is identified through an assessment.
- Refer to the behavioral health provider when it is necessary to prescribe a behavioral health drug, so that the Participant may receive appropriate support and services necessary to effectively treat the problem.
BH-MCO's role in care
The BH-MCO provides access to diagnostic, assessment, referral, and treatment services including but not limited to:
- Inpatient and outpatient psychiatric services
- Inpatient and outpatient drug and alcohol services (detoxification and rehabilitation)
You can call Participant Services at 1-855-235-5115 if you need help referring a Participant for behavioral health services.