Behavioral Health

Behavioral Health Services

Acentra Health, the QIO-like organization for the Arkansas Department of Human Services (DHS), provides utilization and quality control peer review for outpatient behavioral health services to qualifying Arkansas Medicaid beneficiaries. Acentra also provides utilization and quality control peer review for inpatient psychiatric services for Arkansas Medicaid beneficiaries underage of twenty-one.

Required Documents for Authorization Requests

Supporting documentation is required when submitting a prior authorization request. The submitted materials must substantiate the medical necessity of the services being requested in accordance with the guidelines outlined below.

Outpatient Prior Authorization/Extension of Benefits

3-4 recent progress notes

Intake assessment, if beneficiary is a new client

Outpatient Retroactive Authorization Request

Progress notes for each date of service being retroactively requested

If only one service is being requested, it is helpful to submit supporting documentation such as additional progress notes or the intake assessment

Inpatient Authorizations

Request must be submitted within 2 working days of the beneficiary’s admission (excluding state-observed holidays and weekends)

Certification of Need must be submitted

Beneficiary’s name, date of birth, county of residence and sex

Beneficiary’s Medicaid ID number or Social Security Number

Facility name, provider identification number and date of admission

DSM-V-TR diagnosis

A description of the initial treatment plan relating to the admitting symptoms

Current symptoms requiring inpatient treatment

Medication history

Prior inpatient treatment

Prior outpatient or alternative treatment

Parent(s) or legal guardian(s) name, address and telephone number, if available