CurrentHighmark Blueshield NenyPolicy N/A

Communication Between Behavioral Health Practitioner and Non‑Medical Service Entities

This policy governs exchange of information and coordination of care between behavioral health practitioners/providers and non-medical or supportive service entities for members, including requirements for member authorization and documentation. It affects behavioral health practitioners/providers and affiliated non-medical service agencies serving Highmark BlueShield NENY members.

Policy Summary

PayerHighmark Blueshield Neny

PolicyCommunication Between Behavioral Health Practitioner and Non‑Medical Service Entities

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionObtain member-signed release of information before exchanging information with non-medical service entities and document if the member refuses.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3guideline items

1member release required

yesdocumentation

Communication and Documentation Requirements

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ALL of the following

ALL of the following
- Obtain a member-signed release of information to allow exchange with the non-medical entity; if the member refuses to sign, document the refusal in the member's clinical record.
ALL of the following
- Contact the designated non-medical service entity after completion of the initial assessment, diagnostic formulation, and initial treatment plan.
- AND/OR
  - Contact the service entity when there is a significant change in the member's clinical condition, diagnosis, or prognosis.
  - Contact the service entity when the member is hospitalized for behavioral health and/or substance abuse.
ALL of the following
- Document in the member's clinical record that communication occurred.
- Acceptable modes
  - Mail
  - Fax
  - Telephone call

thresholds

Required Provider Actions

Documentation Required

Member-signed release required; document refusals

Obtain a member-signed release of information before exchanging information with any non-medical or supportive service entity. If the member refuses to sign the release, document the refusal in the member's clinical record.

Ask member to sign release when they present for behavioral health treatment and are receiving or being referred to non-medical services.
Record in the clinical record if the member declines to sign the release.

Key Definitions

Non-medical service entities / supportive service agencies — Exchange of information between behavioral health practitioner/providers and other agency/service providers who will serve in a complemen..."},{

DefinitionExchange of information between behavioral health practitioner/providers and other agency/service providers who will serve in a complementary and supportive role for the member.

PurposeSupports continuity and coordination of care through effective, timely, and confidential exchange of information.

ScopeIncludes member-approved communications between behavioral health providers and non-medical/supportive service agencies.

Behavioral health practitioner/provider — Behavioral health practitioners/providers responsible for coordinating behavioral health and related supportive services for members.

DefinitionBehavioral health practitioners/providers responsible for coordinating behavioral health and related supportive services for members.

RoleInitiate and participate in member-approved information exchange with non-medical service entities to ensure continuity of care.

ResponsibilityEnsure communications are effective, timely, and confidential as part of care coordination.

DocumentationDocument member authorization or refusal for information exchange in the clinical record.