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Organizational Providers Reports (Login ID and Password Required)

Access and Crisis Line (ACL)

Under contract with the County of San Diego, UBH has operated the toll-free Access and Crisis Line (ACL) 24 hours a day, 7 days a week since October 1997. The Access and Crisis Line provides suicide and crisis intervention services for children, adults, and older adults; referrals and/or authorizations for mental health services for the Medi-Cal and uninsured populations; and general mental health information and referrals for the community of San Diego. The Access and Crisis Line currently receives more than 100,000 calls per year.

Any individual in the San Diego community who is experiencing a crisis may receive telephone crisis intervention by calling the Access and Crisis Line. The line is staffed by master’s-level counselors who are sensitive to the needs of the caller. Our goal is accurate assessment and/or resolution of behavioral health emergencies. A clinical assessment is conducted that includes evaluation of risk factors (e.g., age, current use of drugs or alcohol); and a lethality assessment, including whether there is a suicide plan; history of violence and/or suicide attempts; and available resources.

Interventions provided by Access and Crisis Line staff focus on the strengths of our clients and helping them recognize the precursors to the crisis. We work with clients to develop strategies that maximize the use of natural support systems and community resources, ensure that interventions are culturally relevant, and support client self-sufficiency whenever possible.

UBH is dedicated to providing the County’s clients with easy access to care. Through the UBH TDD/TTY service for deaf and hearing-impaired clients, and the Language Line Service, with translation capacity for 140 languages, UBH can accommodate the needs of San Diego County’s diverse population. [Top of Page]

Utilization Management (UM)

In the utilization management review process, UBH adheres to the principles and practices of psychosocial rehabilitation, and emphasizes an assessment of multiple dimensions of a client’s behavior and functioning, in addition to diagnosis and symptom severity. UBH has documented that effective treatment plans for mental health and dually diagnosed conditions:

• Are based on face-to-face, clinical and psychosocial assessments;
• Take into account numerous individual, psychosocial, medical, environmental, and financial factors; and
• Change to meet the evolving needs of the client as symptoms either resolve or emerge and/or the individual’s circumstances change.

Our goal is to determine the least restrictive level of care in which a client can be safely treated and that supports the client’s optimum functioning. Using their clinical judgment, knowledge of the service system, and in close consultation with our Medical Director, Utilization Managers monitor care through a process of concurrent review. As a part of this process, they make medical necessity determinations, in accordance with California’s Medi-Cal Medical Necessity Guidelines as stated in Title 9 and the UBH San Diego Public Sector Mental Health Level of Care Guidelines. The San Diego Public Sector Mental Health Level of Care Guidelines reflect Medi-Cal Medical Necessity for Specialty Mental Health Services criteria specified in Title 9 and are utilized for access, authorization, discharge, concurrent and retrospective review.   [Top of Page]

Authorization

Through a toll-free number, UBH Utilization Managers and ACL Intake Counselors are available 24 hours a day, 7 days a week to authorize inpatient admissions and provide utilization review for outpatient services.

UBH provides initial authorizations and concurrent reviews for outpatient Medi-Cal mental health services provided to Adults/Older Adults and children and youth by the outpatient FFS providers, and inpatient reviews for Adult/Older Adults.

Adults/Older Adults
Adults/Older Adults receive authorization for an assessment and thirteen additional therapy sessions. For Adults/Older Adults, concurrent review is conducted for all services that exceed a threshold frequency of 2 visits per month set by the San Diego county Mental Health Adult/Older Adult Clinical Workgroup. For more intensive treatment for adults/older adults, UBH conducts a comprehensive concurrent review utilizing the OAPR and provides authorization, as appropriate.

Children and Adolescents
UBH clinical staff authorize FFS outpatient services for children and adolescents, including access to an array of specialized services, by reviewing treatment requests to ensure that clinically appropriate services are delivered to each client. Utilization Managers currently review an average of 300-500 service requests monthly for the treatment of children and adolescents.

The initial authorization is for an assessment and thirteen additional therapy sessions. If the client needs additional sessions the provider submits an Outpatient Assessment Progress Report (OAPR). The OAPR is reviewed within 7 days to determine that the needs of the client are met and that the treatment plan is sound. If the clinician reviewing the OAPR agrees that the proposed plan meets the needs of the client, additional sessions are authorized. [Top of Page]

Provider Services

UBH has established a Provider Services Line (1-800-798-2254) that allows providers to contact the Clinical Network Services department directly with questions or complaints. By calling the Provider Services Line, providers can:

• Speak with a Clinical Network Services Representative to discuss provider policies and procedures and get information about the appeals process or the status of a specific appeal
• Informally appeal authorization, treatment, and administration issues with clinical staff
• Lodge a complaint of any nature
• Speak with a Claims Department Representative to discuss and resolve claims issues

• UBH Medical Director - San Diego;
• Manager of UBH Clinical Network Services - San Diego (facilitator);
• UBH Quality Manager - San Diego;
• County Mental Health Services Medical Director;
• Manager, Mental Health Services Quality Management;
• County Mental Health Services, Clinical Director for Adult/Older Adult Services;
• Adult Psychiatrist (Provider Network Representative);
• Child Psychiatrist (Provider Network Representative;
• Psychologist (Provider Network Representative); and
• TERM Team Administrator.

All voting members of the committee are licensed clinicians, ensuring that credentialing decisions are made on the basis of a full understanding of the issues involved. By working towards common goals and finding common ground, the Credentialing Committee ensures that the quality of the provider network meets the County’s standards, while promoting positive provider relations.

UBH conducts provider credentialing in coordination with UBH Corporate Provider Services and in accordance with the UBH Credentialing Plan guidelines that meet NCQA accreditation standards. UBH credentialing activities include primary source verification including querying of the National Practitioner Data Book for the following:

• Education and residency if applicable;
• Malpractice history and complaints in the National Practitioner Data Bank, Regional Medicare/Medi-Cal offices, and State medical boards or other appropriate State agency;
• Professional liability insurance;
• Professional License;
• Board certification from American Board of Medical Specialists (ABMS) or equivalent osteopathic certification;
• Drug Enforcement Agency (DEA) certification, as applicable;
• Clinical privileges in good standing at an institution, as applicable.