Section 16.03.09.711 - OUTPATIENT BEHAVIORAL HEALTH SERVICES: PROCEDURAL REQUIREMENTSProviders must enroll in the IBHP with the contractor and meet both the credentialing and quality assurance guidelines of the contractor.
01.Administer IBHP. The contractor is responsible for administering the IBHP, including: eligibility verification, management of behavioral health service provision, behavioral health claims processing, payments to providers, data reporting, utilization management, and customer service.02.Authorization. The contractor is responsible for authorization of covered behavioral health services that require authorization prior to claim payment.03.Complaints, Grievances, and Appeals. Complaints, grievances, and appeals are handled through a process between the contractor and Department that is in compliance with state and federal requirements. Participants must utilize the complaint, grievance, and appeal process required by the contractor prior to initiating an administrative appeal with the Department.Idaho Admin. Code r. 16.03.09.711