Intakes / Referrals
It is the policy of Sunrise Behavioral Health, L.L.C. to ensure appropriate, adequate, and medically necessary services. Sunrise Behavioral Health, L.L.C. (hereinafter referred to as Sunrise) requires the employees, including, but not limited to, the medical director, clinical director, and qualified mental health professional to abide by the following policies:
Initial Response to Referrals-Prescreening
Client referrals come to Sunrise in many different forms, such as email, fax, and telephone correspondences. The Sunrise Intake Coordinator, licensed clinician, or Direct Supervisor returns a call within 24-48 hour. On the phone, there is an initial pre-screening, the clinician explains the intake process with the client, and obtains insurance and demographic information that is entered into ICANotes. Staff additionally explains the type and structure of services, basic company policies, and general information regarding Sunrise. The staff offers clients the choice to receive services. If the referral requests to continue with beginning services, the clinical team continues with the intake process. Executive Administrative Assistants check insurance eligibility. If the insurance of the referral is not accepted, the Intake Coordinator contacts the referral to relay the information. Intake Coordinator explains the process the referral needs to go through in order to obtain services with our agency, or offers referrals to other agencies.
Clinical Team Member Obtains General Information and Consent
A clinical team member reviews all policies, procedures, and consent forms with the client or guardian, if applicable. The referred client and/or guardian completes consent form packet. Consent forms include HIPAA acknowledgements, consents to treat, release of records from outside entities of the client’s choice, recipient’s rights, and acknowledgement of their involvement and receipt of a treatment plan for their provided services. Clients or guardians acknowledge they can receive services at any agency of their choice. Upon completion of consent forms, a client file is created.
An Executive Administrative Assistant creates a hard copy and electronic file for the client. All consent forms and intake paperwork are scanned and stored in the client’s electronic file, found in ICANotes software. A hard copy file will hold the originals of all paperwork obtaining original signatures of the client, and guardian, if applicable. After being scanned and uploaded into ICANotes, the unsigned paperwork is shredded immediately. Hard copy files are stored in locked cabinets in locked offices, away from where clients receive services.
Clinical/Medical Director Meeting
After the client meets with a licensed clinician, the clinical team member, Clinical Director and/or Medical Director assess for diagnoses and medical necessity. If services are warranted, treatment goals are also discussed and identified. The assessment, mental status exam, and CASII/LOCUS are scanned and uploaded into ICANotes. Copies with original signatures will be filed in hard copy files. The Clinical Director and/or Medical Director who completes the evaluation, mental status exam, and CASII/LOCUS become the coordinating QMHP for the case.
Treatment Plan Creation
Upon completion of all intake processes and assessments, a treatment plan is created for the client. The Treatment Plan includes the client’s basic, service-relative information, such as name, Medicaid ID, date of birth, diagnoses, and strengths and barriers to treatment. The Treatment Plan outlines the three major dimensions that will be addressed in treatment. Under each dimension, long term goals, short term goals, and therapeutic interventions are outlined, along with start date, end date, and frequency for short term goals and therapeutic information. Upon completion of the Treatment Plan, the client, guardian, if applicable, Direct Supervisor, Clinical Director, and Medical Director sign the treatment plan. Based on the information received, a Prior Authorization Request (Medicaid FA-11A form) is completed and sent to Medicaid for authorization of services.
Requesting Services through Insurance Companies
When Treatment Plan is completed and signed, a Prior Authorization Request (NV Medicaid FA-11A form or other comparable form) is compiled and sent to NV Medicaid. This form documents information, such as demographics, diagnoses, family history, treatment plan, and psychiatric history. The FA-11A form also indicates the services requested, including duration and frequency. A Prior Authorization Request covers a 90 day period.
Receiving Approval from Insurers
The response from Medicaid or other insurance agencies typically take 7-10 business days to determine if services are approved or denied. If services are approved, service providers are assigned to the case. Upon acceptance of the case, service providers are required to review the client’s treatment plan and sign it. Contact with client is made in order to begin services with the client. If Medicaid denies services, the client is contacted with information regarding the denial, such as an explanation and steps for appealing the decision through a fair hearing. If the services are rendered not medically necessary, Sunrise Behavioral Health will not continue services with the client. If the client has an issue with their insurance resulting in a denial of services, a Sunrise employee will explain the requirements for insurance and the process the client might need to go through to obtain insurance coverage for their mental health or medical needs.