NORTHPOINTE BEHAVIORAL HEALTHCARE SYSTEMS
POLICY TITLE: BC/BS – OPC Program
MANUAL: Clinical
ORIGINAL EFFECTIVE DATE: 4/1/01
REVIEWED/REVISED ON DATE: 4/16/15
REVISIONS TO POLICY STATEMENT:
YES
NO
PAGE: 1 of 1
SECTION: Miscellaneous
BOARD APPROVAL DATE: 9/26/13
CURRENT EFFECTIVE DATE: 9/3/13
OTHER REVISIONS:
YES
NO
APPLIES TO:
Any individual receiving services from Northpointe who has Blue Cross/Blue Shield (BC/BS) or Federal BC/BS as a
payor source.
POLICY:
It is essential that a licensed psychiatrist be a member of the multidisciplinary team. The team is responsible for the
provision and ongoing evaluation of the individual’s care/services.
PURPOSE:
This policy outlines the requirements for psychiatric intervention, individual medical records and utilization
evaluation for the Blue Cross/Blue Shield of Michigan approved “Outpatient Psychiatric Care” Program.
PROCEDURES:
1.
Each selected OPC must have at least one Board certified psychiatrist on its staff. If part-time, the
psychiatrist must spend a minimum of fifty percent (50%) of his/her time at the selected OPC.
Exception to this requirement will be considered for factors such as unavailability of Board certified
psychiatrists or low clinic volume.
2.
The psychiatrist assumes overall responsibility for coordinating the care of the patients. Significant
involvement by a psychiatrist in an OPC facility includes, but is not limited to: regularly scheduled
hours in the facility, approval of the initial evaluation within 10 working days after the intake,
certification of the diagnosis, certification of the treatment plan, evaluation of progress at least quarterly,
intervention for medical reviews, intervention for level of care changes, review of termination of
treatment/approval for psychological testing prior to administration, copies of utilization management
meeting minutes, and supervising staff. NBHS will utilize a written Statement of Certification
specifying diagnosis, treatment, and assignment of therapists indicating it is necessary and appropriate
(NBHS Form.cl.007) for individuals who are covered by any Blue Cross plan.(MI-Child is not a BC
Plan) including Federal Blue Cross/Blue Shield Plans.
3.
The psychiatrist must participate actively in concurrent utilization review and case conferences for these
individuals.
4.
All BC/BS plans require a quarterly Periodic Review
CROSS REFERENCE:
NBHS Form.cl.007 BCBS OPC Certification
NBHS Utilization Management Manual
BC/BS Outpatient Psychiatry Care (OPC) Facility Application, General Information