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Tip: When to start and stop the observation clock

Case Management Weekly, June 30, 2010

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Managing patients in need of mental health services requires the ability to properly navigate the access and initiation portion of the process. Many insurance companies outsource the management of mental health benefits to agencies. Those agencies authorize assessment teams to evaluate and set standards for level of care. Only these authorized evaluators may arrange services for plan members.

Uninsured patients—or those with Medicaid—often must be seen by a team that has a contract with the state. These regulations mean that case managers managing a crisis in the ED must carefully follow specific protocol to obtain the benefits and services that may be critical to patients in need.

Before evaluating patients for mental health benefits case managers should:

• Ask patients for their insurance card
• Contact the insurance company
• Determine whether benefits for the patient are current
• Determine which evaluators can activate mental health benefits
• Learn which providers are in network for particular patients

This week’s tip is adapted from Emergency Department Case Management: Strategies for Creating and Sustaining a Successful Program published by HCPro, Inc. For more information about this book or to order your copy, visit the HCMarketplace.

Do you have a question about a case management topic? Send it to Associate Editor Ben Amirault at bamirault@hcpro.com. An answer to your question might appear in a future issue of Case Management Weekly

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