Blue Cross Blue Shield Of Kansas Discontinues Prior Authorization Of Mental Health Services – But Implements Retrospective Claim Review

On January 1, 2016, Blue Cross Blue Shield of Kansas (BCBSKS) discontinued its prior authorization requirement for mental health services and implemented a retrospective claim review process to assess medical necessity. BCBSKS contracts behavioral health network management to New Directions Behavioral Health, which is implementing the new approach. BCBSKS developed the new approach in collaboration with New Directions.

Previously, BCBSKS required prior authorization nearly all professional outpatient treatment after the eighth visit. The new approach is intended in part to ensure that BCBSKS behavioral health benefits comply with the federal Mental Health Parity and Addiction Act of 2008 (MHPAEA), which . . .