Prior Auth Required

4797B - Responsibilities and Consent form to the member document how they reviewed the DHS

This procedure appears on the selected insurer prior authorization source.

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Procedure / ServiceResponsibilities and Consent form to the member document how they reviewed the DHS
Procedure / Service Description

**Provider must review and explain the Behavioral Health Home Services Rights, - *Provider must ensure that member has current MA coverage. **Provider must review and explain the Behavioral Health Home Services Rights, Responsibilities and Consent form to the member document how they reviewed the DHS-4797B with the member and document the member’s consent to receive BHH services. The member’s consent may be documented either by keeping a DHS-4797B signed by the member in the

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.