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Questions?
Check your provider manual (PDF) for answers. Or call us at 1-866-638-1232 (TTY: 711). We're here for you Monday through Friday, 8 AM to 5 PM.
Whole health is the goal
Whole health is the goal
We help members and their families by making key connections between physical, mental and behavioral health, as well as disability, wellness and prevention. These are the connections that help members take steps toward whole health.
Behavioral health includes services provided for the assessment and treatment of mental health and substance use disorders. Members managing or at risk for mental health, addictive or other behavioral disorders have access to services to meet their needs.
We work with members and providers to focus on prevention and wellness by:
- Screening for issues that could lead to illness and treating them early with a whole-health approach
- Offering care coordination services to our members and providers to support integrated behavioral health care
Treating a member in crisis?
Behavioral health emergencies: Dial 988
If a member is having a behavioral health emergency, they can call, text or chat 988. This is the new number for the 988 Suicide & Crisis Lifeline. If they have thoughts of harming themselves or someone else, their trained counselors can help, 24 hours a day, 7 days a week. They also have the option to chat online with a counselor through the Lifeline Chat service.
Medical emergencies: Dial 911
If a member is having a medical emergency and needs help right now, they can call 911 or go to the nearest hospital. Members can use any hospital for emergency care, even if it isn’t in our network. They just need to show their member ID card.
Special Needs Unit
Members can also call our Special Needs Unit for help at 1-855-346-9828 (TTY: 711). We’re here Monday through Friday, 8 AM to 5 PM, to link them to helpful mental health resources.
Behavioral health coverage
Behavioral health coverage
Basic behavioral health
These services are provided by medical professionals or behavioral health consultants in medical clinics. Some common services include:
- Screening for common mental health conditions
- Screening for alcohol or substance use issues
- Medication management
- Coordination of referrals to specialized behavioral health services
Members have access to behavioral health education and resources on the:
- Member behavioral health page
- Member resources and services page, which includes the community resource tool
Mental or behavioral health professionals provide these services in a setting that works best for the member and their family. Outpatient clinics or intensive treatment programs may provide nonemergency services. Some members may also be eligible for home and community-based services.
Everyone wins with coordination of care
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Everyone wins with coordination of care
Working closely with providers to coordinate medical and behavioral care for members ensures appropriate screening, evaluation, treatment and referral for:
- Physical health
- Behavioral health or substance use disorders
- Dual or multiple diagnoses
- Developmental disabilities
TiPS (Telephonic Psychiatric Consultation Service Program)
TiPS is a Pennsylvania program that provides child psychiatry services to children insured by the Children’s Health Insurance Program (CHIP). It’s designed to help primary care providers (PCPs) who are treating children (under age 19) with common behavioral health concerns. TiPS offers real-time peer-to-peer resources for PCPs seeking immediate psychiatric consultation. The program provides one psychiatric team per CHIP zone and is designed to:
- Ensure access to quality services in the appropriate setting based on need
- Mitigate the lack of available child psychiatry resources
Whole health means healthier members
Whole health means healthier members
When physical and behavioral health providers work together, members benefit. Our behavioral health providers and PCPs share information with that goal in mind. This results in appropriate and effective coordination between physical and behavioral health care.
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PCPs screen for behavioral health issues
If you’re a PCP, you’ll want to:
- Use behavioral health screening tools
- Treat behavioral health issues within your scope of practice
- Refer members to behavioral health providers, when appropriate
Behavioral health providers screen for physical health issues
If you’re a behavioral health provider, you’ll want to:
- Screen members for coexisting physical issues
- Refer those who have untreated physical health issues to their PCP (with consent)
- Provide physical health care services only if you’re licensed to do so
- Share any concerns with their PCP and work together on a care plan (with consent)