Treatment Request Process
Member is referred (self/PCP/specialist/other) for Behavioral Health/Substance Use Disorder services via fax/phone/Regal Express Access(REA)
With Behavioral Health referral, the member receives a letter with instructions to call the Behavioral Health Team > Number will generally be medical group specific. Below are examples:
| Regal Medical Group (RMG) | 844-771-1004 |
| Affiliated Doctors of Orange County (ADOC) | 844-528-1986 |
| Lakeside Medical Group (LMG) | 833-489-0541 |
| Bakersfield Family Medical Center (BFMC) | 833-227-3015 |
| Coastal Communities Physician Network (CCPN) | 833-409-2471 |
| High Desert Medical Group (HDMG) | 833-409-2471 |
| Heritage Victor Valley Medical Group (HVVMG) | 877-566-7080 |
| Desert Oasis Health Care (DOHC) | 844-374-3571 |
| Sierra Medical Group (SMG) | 877-566-7081 |
Member calls Behavioral Health Team and requests provider name and contact number
Behavioral Health Team checks eligibility
Behavioral Health Team gives member provider name(s) and contact number
Member calls provider and makes appointment
Member calls Behavioral Health Team and gives appointment details
Behavioral Health nurse generates authorization for initial assessment and 1 follow up visit
Authorization letters generated and sent to Behavioral Health provider, PCP, and member
Behavioral Health Provider treats member and submits Initial Treatment Request (ITR) for additional sessions
Behavioral Health nurse may generate authorization for an additional 6 sessions for Psychiatry (MD/NP and 12 sessions for Therapy (LCSW, PsyD, PhD)
Once Behavioral Health Provider has treated member for 6 sessions for Psychiatry (MD/NP and 12 sessions for Therapy (LCSW, PsyD, PhD) and still requires additional care. Behavioral Health Provider submits Follow up Treatment Request (FTR)
Based on FTR, Behavioral Health nurse may generate authorization for 6 sessions for Psychiatry (MD/NP and 12 sessions for Therapy (LCSW, PsyD, PhD)
Completed ITRs/FTRs are stored in the member’s electronic file and sent by Behavioral Health Team to PCP to be stored in the member’s PCP chart
If medical necessity is not indicated at any point, the Behavioral Health Medical Director communicates directly with the Behavioral Health Provider for a 1:1
BEHAVIORAL HEALTH TEAM FAX: 714-908-7257