General Guidelines for Referrals

Provider Type

  • Physicians 
  • Participating Physician Groups (PPG) 
    (does not apply to HSP)
  • Hospitals
  • Ancillary

The following situations warrant referring a member to a behavioral health provider:

  • Moderate to severe symptoms of depression that are not responding to treatment with first-line antidepressant medications.
  • Suicidal ideation.
  • Schizophrenic disorders where Clozaril® or risperidone or similar psychopharmaceuticals are being considered.
  • Bipolar disorder where lithium, valproic acid, carbamazepine, or similar psychopharmaceuticals may be needed.
  • Eating disorders.
  • Psychological issues for outpatient referral, such as anxiety, phobias, stress, and depression.
  • Transition of care from psychological to medical facility, such as a skilled nursing facility (SNF), or vice versa.
  • Member is inpatient and a behavioral health provider is consulted or behavioral health services are ordered as part of the discharge plan.
  • Alcohol or other substance abuse or dependence that is not responsive to brief interventions to reduce intake, motivational enhancement therapies and self-help programs, or those in need of detoxification.
  • Transition from detoxification to medical bed.
  • Psychiatric consultation, psychological/neuropsychological testing or psychiatric evaluation requested at a facility.
  • Catastrophic illness requiring behavioral health support.
  • Difficult placement due to medical and behavioral health problems.
  • Pain management with substance abuse issues.
  • Frequent emergency visits for behavioral health diagnoses or pain issues.
  • Autism spectrum disorder.