Intensive Outpatient Program (IOP) Request Form - Blue Cross and 2025

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The document is an Outpatient Authorization Request Form from Highmark Blue Shield's Medical Management and Policy Department. It outlines the submission instructions for healthcare providers to request authorization for various medical services, emphasizing the necessity of including supporting clinical documentation. The form collects essential patient and provider information, service details, and includes sections for internal review outcomes.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the purpose of the Outpatient Authorization Request Form?

The form is used to request authorization for outpatient services from Highmark Blue Shield's Medical Management and Policy Department.

What information is required to complete the form?

You must provide patient details, provider information, diagnosis codes, procedure codes, and type of service requested, along with supporting clinical documentation.

What happens if I submit the form without supporting clinical documentation?

Requests missing clinical information will be returned to the requesting provider, which will delay the review process.

How should I submit the completed form?

Fax the completed form to the Medical Management and Policy Department at 888.236.6321 or 800.670.4862 (Delaware).

Can I edit the document on DocHub?

Yes, you can edit the document on DocHub by uploading it and using their editing tools to fill in or modify any required fields.

What is considered intensive outpatient treatment for mental health?

Intensive Outpatient Programs (IOPs) are structured treatment programs that provide a higher level of care than traditional outpatient therapy while remaining less intensive than inpatient programs.

What is the difference between intensive therapy and regular therapy?

It most cases, standard outpatient therapy encompasses one or two hours per week. Intensive outpatient therapy cranks up that amount to a minimum of 10 hours per week. This extended amount of time gives you the greatest chance of success in your healing process.

What do outpatient services mean in mental health?

Outpatient mental health treatment is a type of mental health care where people receive therapy, counseling, or adolescent psychiatric services without staying overnight in a hospital or facility. Instead, they visit a clinic, therapists office, or counseling center for scheduled appointments.

How much does IOP cost per day?

On average, the cost of IOP can range from $250 to $650 per day in private facilities, with comprehensive programs potentially reaching upwards of $3,000 to $10,000 for the entire course of treatment.

How long are outpatient mental health programs?

The length of an IOP varies depending on each persons needs and progress in their recovery process. Generally speaking, an IOP can last anywhere from two weeks up to two or three months, or even longer, depending on the severity of the addiction and the progress made in treatment.

Intensive Outpatient Program (IOP) Request Form - Blue Cross and 2025

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