QUEST Integration – Behavioral Health Case Management

HMSA’s behavioral health services can assist QUEST members in need of behavioral health intervention and triage, and assist QUEST members in finding an appropriate behavioral health care provider as needed. Intensive case management of high-risk patients is also available.

Case management services may include:

• Linking the member to resources and services.
• Educating the member, family, and other sources of support.
• Maintaining interaction with providers.
• Coordinating and assessing care by monitoring patient registration.
• Assisting with benefit flexing.
• Advocating for the member's needs.

Pre-certification

Pre-certification from HMSA’s behavioral health services for QUEST members is required before the following services are rendered:

• Services through a provider who is not part of HMSA’s QUEST network of providers.
• Services provided out of state to adults.
• Services provided out of state to children. Children under QUEST include young adults through age 20.

To obtain pre-certification, call HMSA’s Behavioral Health Services QUEST (Carelon Behavioral Health^SM).

Services such as interisland travel, lodging, language translation, and other services provided to the patient with access to care must be arranged before the needed services are scheduled by calling Provider Services for The HMSA Plan for QUEST Members.

Confidentiality and Security

Patient information is maintained with the utmost confidentiality and security in accordance with the stringent guidelines established under the federal Health Insurance Portability and Accountability Act. Information is used only to identify patients as is appropriate for case management as well as to analyze community standards of care to establish best practices.

Revision History