Mental Health Services & Behavioral Health Treatment

CenCal HEALTH members have access to services addressing mental health and substance use. Coverage and provision of these services are shared between CenCal Health, County Behavioral Health Services and State FFS. 

CenCal Health Behavioral Health Department is responsible for Mental Health Benefits for those who are determined to be mild to moderate in impairment. The Behavioral Health Department reviews authorization requests for Behavioral Health Treatment.

Please use the Behavioral Health Care Coordination Request Form when requesting care coordination for mental health or substance use services.

Outpatient Services

CenCal Health Primary Care Physicians (PCP) are responsible to provide alcohol screening, brief depression screenings, and referrals for treatment. CenCal Health Mental Health Benefits includes; psychotherapy, psychological testing, monitoring of drug therapy, outpatient lab services and psychiatric consultation. 

Members can start mental health services (psychotherapy or medication management) by contacting the Behavioral Health Department for assistance in locating a provider.

Members and Primary Care Physicians (PCP) can find a list of providers by location and specialty on the CenCal Health Provider Directory.

Please call the Behavioral Health Provider Line at (805) 562-1600 for questions related to outpatient mental health services or Behavioral Health Treatment (ABA) services. CenCal Health Members can contact The Behavioral Health Department directly through Member Services at (877) 814-1861.

Claims with past date of services see our Claims section

Mental Health Provider Content

Click here for information on Spravato 

Covered Benefits:
Screening, providing brief behavioral counseling interventions (“SBIRT”) and professional fees associated with visits when a provider, within the scope of his or her practice, prescribes medications to reduce symptoms of withdrawal.

Carved Out Benefit: 
The County Department of Behavioral Health provides treatment for Members with Substance Use Disorders.
Members must be referred and contact the Santa Barbara County ACCESS line 1 (888) 321-2843 or the San Luis Obispo County ACCESS line 1 (800) 838-1381 to be screened. 

Screening Tools:

Resources:

Forms:

Counties of Santa Barbara and San Luis Obispo

Behavioral Health Treatment (ABA) Provider Content

Behavioral Health Treatment (BHT) are behavioral interventions and include modalities services such as Applied Behavior Analysis (ABA).  

CenCal Health provides coverage of all medically necessary BHT services for eligible beneficiaries under 21 years of age for which a licensed physician, surgeon, or psychologist deems that BHT services are medically necessary.

Forms:

Templates:

Resources:

Primary Care Provider (PCP) Screening Tools & Resources

CenCal Health covers screening members for alcohol use and providing brief behavioral interventions at primary healthcare.  Members with primary Medi-Cal Insurance who meet DSM V criteria for substance use disorder must be referred to County Alcohol and Drug Services for appropriate out-patient and residential treatment services. Members with primary Medicare Insurance who meet DSM V criteria for substance use disorders must be referred to appropriate resources that accept Medicare.

Forms:

ABA Referral form

Resources:

Tools:

Services for Alcohol and Other Drug Use:

Authorization Resources

Authorizations are required for all case managed CenCal Health members; however, there are a number of exceptions to this rule such as Psychotherapy and Medication Management as referrals (RAF) and TARs are not required for these services.  For authorization requirements, please reference Section E6 & E7 of the Provider Manual.

Resources:

Please reference the scenarios below when submitting authorizations via the Provider Portal or submitting by paper authorization requests.  If submitting via the paper authorization, please include the Behavioral Health Department Fax Cover Sheet and fax all of your details to (805) 681-3070.  For additional resources, please reference the Authorization Section of our website.

Claims & Billing

Effective March 1, 2022, CenCal Health will be processing claims with 2021 and 2022 Dates of Service (DOS).  These claims should be submitted to CenCal Health, not The Holman Group.  Claims can be submitted on the portal, electronically or via paper.  If you need assistance with the portal, or have questions please feel free to contact our Claims Customer Service Representatives at (800) 421-2560 ext. 1083.  We are here to help! 

For additional resources please reference the Claims Section of the CenCal Health website.  Providers can use the procedure codes and modifiers outlined within the CenCal Health Provider Manual (Section E7 for Mental Health Providers & Section E6 Behavioral Health Providers).

Authorizations

Authorizations are required for all case managed CenCal Health members; however, there are a number of exceptions to this rule such as Psychotherapy and Medication Management as referrals (RAF) and TARs are not required for these services.  For authorization requirements, please reference Section E6 & E7 of the Provider Manual.

Authorization Resources:

For additional resources, please reference the Authorization Section of our website.