Service Approvals

What is a service approval and what services require a service approval?

You and your provider will decide the services you need. Services needed for an emergency healthcare condition do not need approval before you can get them. For the services that must be approved, your provider or clinical team will ask contact Cenpatico for approval. If a Title XIX/XXI covered service in your Service Plan is denied, reduced, or ended, you will receive notice and have the right to file an appeal. The Member Handbook describes the process for filing an appeal. This can be found on page 52 in the section called, “What is an appeal and how do I file an appeal?” Behavioral Health Services that require approval include:

  • Non-emergency admissions to a hospital or Behavioral Health Inpatient Facility Sub-Acute Services (BHIF-SAF);
  • Continued stay in a hospital or Behavioral Health Inpatient Facility Sub-Acute Services(BHIF-SAF);
  • Admissions to and continued stay in a Behavioral Health Inpatient Facility Residential Treatment (BHIF-RTC);
  • Admissions to and continued stay in a Behavioral Health Residential Facility (BHRF);
  • Admissions to and continued stay in a Behavioral Health Therapeutic Home (BHTH);
  • Admissions to and continued stay in Home Care Training for Home Care Clients services (HCTC);
  • Initiation of and continuation of out-of-network (OON) outpatient services;

For more information you may contact customer service at (866) 495-6738