Behavioral Health 

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Prior Authorization

WellFirst Health provides all Utilization Management services for the behavioral health needs of our members. A prior authorization is required for the following mental health and substance use services:

  • Detox
  • Inpatient
  • Residential
  • Partial Hospitalization/Day Treatment
  • Intensive Outpatient
  • Out-of-Network Outpatient
  • In-home therapy

To request a prior authorization or notify WellFirst Health of an urgent/emergent admission:

Be prepared to provide the following information (not an inclusive list):

All services 

  • Provider tax ID and address
  • Member name, birthdate and WellFirst Health ID #
  • Current diagnosis
  • CPT codes
  • Medications
  • Length of authorization
  • Clinical information supporting level of care being requested

Inpatient services

  • Admission date
  • Attending health care provider name
  • Provider contact name and phone number for concurrent review
You must notify us of any urgent/emergent inpatient mental health or detox admission within 24 hours of admission