Behavioral Health Urgent Care (BHUC) ILOS
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Defines Medicaid utilization management guidelines for BHUC services in North Carolina for individuals age 4 and older experiencing behavioral health crises; covers triage, assessment, intervention, staffing, program requirements, and limits of stay.
No material clinical or coverage changes in this revision.
Coverage criteria for Behavioral Health Urgent Care (BHUC)
Admission (Initial BHUC services)
Covered when presentation requires urgent or emergent triage and the person is age 4 or older.
Comprehensive Clinical Assessment is not mandatory; a licensed professional completes a rapid assessment as part of triage and initiation of BHUC services.
Length of stay / Observation
Limitations on stay and observation.
Continuous assessment required during extended observation per NC 122C-263.2.
A Behavioral Health Urgent Care (BHUC) is intended to serve as an alternative to a community hospital Emergency Department (ED) for individuals presenting with urgent or emergent behavioral health needs, but it is not a replacement for ED care when ED services are clinically required. BHUC provides rapid triage, crisis risk assessment, evaluation, and stabilization or referral to the most appropriate level of care.
Services and treatment provided in BHUC
Crisis intervention / Brief psychiatric & nursing care
Comprehensive Clinical Assessment not required to initiate BHUC; a licensed professional completes rapid assessment and documents disposition and follow-up plans.
Procedure codes and key coding limits
Provider requirements, notifications, and documentation
Prior authorization not required; SAR notification within 72 hours
No prior authorization is required for BHUC services. For admissions that qualify as a pass-through, submit Service-Associated Requests (SARs) within 72 hours of admission to meet program notification requirements.
Use NC Tracks guide for claims and billing processes
Follow NC Tracks Provider Claims and Billing Assistance Guide for Medicaid behavioral health claims and any prior authorization or billing processes; see the NC DHHS BHUC resource page and NCTracks provider manuals for detailed instructions.
- NC DHHS BHUC document page: https://www.ncdhhs.gov/documents/files/state-funded-behavioral-health-urgent-care-bhuc
- NC Tracks Provider Claims and Billing Assistance Guide: nctracks.nc.gov/content/public/providers/provider-manuals.html
No step-therapy directives specified for BHUC
No step-therapy requirements are specified for BHUC. BHUC is intended to provide rapid triage, brief assessment, stabilization, nursing and psychiatric interventions, case management, and discharge planning as an urgent alternative to emergency departments.
- BHUC services include triage, brief assessment, crisis de-escalation, nursing and psychiatric interventions, brief case management, resource referral, medication management, and referral coordination.
Initiate triage/interventions and track required process measures
Provide rapid triage and begin BHUC interventions immediately upon urgent/emergent determination; document assessments, interventions, and disposition per program requirements and track expected process measures.
- Track provider details, diagnosis, follow-up appointments, clinic wait and service times, and urgency levels as process measures.
- For managed (concurrent) admissions, include an assessment and discharge/disposition plan.
Document assessment and discharge/disposition plan for managed admissions
For managed (concurrent) admissions, an assessment and a discharge/disposition plan must be completed and documented; include provider details, diagnosis, scheduled follow-up, and clinic wait/service times as part of tracking.
- Assessment elements should include treatment history, bio-psycho-social data, medical status, mental status, diagnoses, and urgency/risk status.
- Discharge planning must connect the individual to the least restrictive appropriate level of care with follow-up arranged (target within 7 days).
Adhere to DMH/DD/SAS RMDM Items 1–12 for service notes
Follow the DMH/DD/SAS Records Management and Documentation Manual 45-2 (RMDM) Items 1–12 (Contents of a Service Note, Chapter 7) when completing clinical records for BHUC services.
- Clinical documentation should capture the required service note contents as specified in RMDM Chapter 7, Items 1–12.
- Include assessment elements compiled by qualified professionals: self-reported history, bio-psycho-social data, case management details, medical and mental status, diagnoses, and urgency/risk status.
SAR submission within 72 hours to avoid notification non-compliance
Failure to submit SARs within 72 hours of admission may result in non-compliance with program notification requirements and associated risks to coverage or program standing.
- SARs are required within 72 hours of admission for a pass-through.
Comply with state regulations and documentation standards to avoid coverage issues
Ensure compliance with applicable State regulations (10A N.C.A.C. 27G and NC G.S. 122C) and the RMDM documentation standards; noncompliance may trigger coverage or claim adjudication issues.
- NC Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMH/DD/SAS) requirements and the cited state regulations are referenced for program operation and documentation standards.
- Noncompliance with these regulations or documentation standards may affect claims and coverage.
Limits on visits and stays
Definitions used in this policy
Background and scope
BHUC services are designed for individuals aged 4 years and older who are experiencing behavioral health crises related to mental health, substance use disorder, and/or intellectual/developmental disability. The program focuses on rapid triage, crisis risk assessment, brief interventions (including medication management when needed), stabilization, and referral or linkage to an appropriate follow-up level of care.
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