We value the participation of each of our Network Providers. In fact, helping our Members receive effective treatment from you is one of the most important reasons we are here. We look forward to the opportunity to work in partnership with you and we hope you enjoy your experience with us. Please contact us if you have comments or suggestions or if we can be of service to you in any way.
Preferred Mental Health Management (PMHM) welcomes the following providers into its Provider Network:
- Doctorate Level Psychologists (Ph.D.)
- Licensed Clinical Social Workers (LSCSW)
- Licensed Chemical Dependency Counselors (LCDC)
- Psychiatrists (M.D.)
Psychiatric and Substance Abuse Treatment Facilities (offering one or all of the following levels of care):
- Inpatient Treatment
- Partial Day Treatment
- Intensive Outpatient Treatment
PMHM Outpatient Provider Applications and Checklist
Members may access care in a variety of ways. Some benefit plans allow members to have access to PMHM’s providers through an online or paper Provider Directory. Others may require the member to call PMHM to access care.
In plans which use PMHM as the treatment gatekeeper, when the member contacts PMHM, he or she receives an immediate telephonic assessment by a PMHM Staff Psychologist.
During this process, PMHM’s Psychologist obtains enough information to evaluate the member’s specific needs and refer the patient to an appropriate provider or treatment facility.
PMHM’s automated provider information system allows for searches by both zip code and specialty. The specialty information available on each provider includes language(s) spoken, diagnostic specialties, expertise with specific populations, and previous treatment outcome/patient satisfaction results.
In addition to speaking with the PMHM Staff Psychologist, members who call also speak with a Patient Relations Coordinator (PRC). The PRC works with the caller to establish insurance eligibility and explain benefits. The PRC is available if the caller has questions or wishes to change providers.
In its Quality Assurance Program, PMHM surveys Members and Providers about their treatment referral experience. Every patient who receives treatment with a PMHM Network Provider receives a Patient Satisfaction Survey. This survey reviews the patient’s satisfaction with PMHM’s referral process and the Network Provider’s accessibility and availability. In addition, the survey asks the patient’s opinion regarding his or her treatment outcome.
A key component of PMHM’s Quality Assurance Program is the exceptional partnerships we have with our Providers. PMHM’s Patient Relations staff works hard to maintain a high level of Provider satisfaction. To track Provider satisfaction, we request feedback on many aspects of our referral program.
PMHM uses the survey feedback in identifying provider-specific and system-wide problems, as well as in developing new solutions and program innovations.
Program Access & Languagess
PMHM’s assistance is just a phone call away. As a Member, you may call PMHM’s toll-free hotline seven-days a week, twenty-four hours a day. PMHM’s services are available 365-days a year.
For non-English speaking members, PMHM provides instantaneous phone translation services (Spanish + more than 140 different languages). PMHM’s Crisis Intervention Case Managers are available evenings, nights, weekends and holidays to meet Members’ needs. Any call of an emergency nature is handled immediately by one of our Crisis Intervention Managers or a PMHM Staff Psychologist, as clinically indicated.
PMHM’s Care Managers and Staff Psychologists are available 24-hours a day for consultation, referrals and crisis intervention.
If your call is of an emergency nature, do not call PMHM, please dial 911.
Providers’ Frequently Asked Questions
Is PMHM an insurance company?
PMHM is not an insurance company, it is a behavioral managed care firm. PMHM often works with insurance companies or payers to preauthorize outpatient treatment and precertify inpatient care.
I have heard about PMHM’s Professionally Guided Care. What is it?
PMHM’s management program is different from other managed care companies. Whereas many managed care firms use nurse reviewers to make decisions about the type and amount of treatment to authorize, PMHM uses doctorate level Psychologists.
A PMHM Psychologist reviewer will work closely with you to monitor the patient’s care, perhaps requesting testing and other information not required with other firms. Also, if you are having difficulty with treatment on a given patient, you may call and get a second opinion from the PMHM Psychologist.
How do Members access my treatment services?
This varies. In some plans, Members access your services through a Provider Directory. Other plans require the Member to first call PMHM to obtain a treatment referral. When PMHM refers a patient to you, you will receive a letter with the patient’s identifying information, along with a specified number of treatment visits.
PMHM will provide the patient with your contact information and he or she will call you to make an appointment. To obtain the patient’s benefits or to get more information, call 800-776-4357.
How does the Member receive a referral for behavioral benefits?
The Member calls PMHM and discusses his or her needs with a PMHM Staff Psychologist. During this discussion, a referral is made.
What information will I receive from PMHM?
You will receive a verbal treatment authorization, followed up with the same information by mail.
How do I request a treatment extension?
Information will be included with your initial Treatment Authorization. If you have misplaced this information, please call PMHM at 800-776-4357.
How do I make a referral to a different Provider?
All Provider referrals must be handled through PMHM. Just contact the Patient Relations Coordinator (PRC) who made your initial Treatment Authorization.
Where do I send claims?
Mail claims to:
7309 E 21st Street North, Suite 110,
Wichita, KS 67206
What do I do if one of my patient’s claims is denied?
You may appeal this decision by requesting an appeal in writing from PMHM. In your correspondence please provide all pertinent information such as the Member’s identifying information, the patient’s name and address and also the provider’s information.
You may send your appeal request to:
Preferred Mental Health Management, LLC,
7309 E 21st Street North, Suite 110,
Wichita, KS 67206
What type of multilingual services does PMHM offer?
PMHM has Spanish language capabilities for patients from the time of the initial call, continuing through the referral process. In the event that other languages are needed, PMHM has 24-hour access to a comprehensive language translation service.
Utilizing this service, PMHM is able to access the appropriate translator within five minutes of the initial call. This translation service enables PMHM to effectively communicate with and meet the service needs of all of its non-English-speaking Covered Members.
PMHM also has many multi-lingual Providers across the nation, and will make every effort to customize its Network to include Providers with foreign language capabilities for a given location.
PMHM’s Professional Guided Care Program SM seeks to ensure that each patient receives the correct treatment in the most appropriate treatment setting. After the expiration of PMHM’s initial authorization, the Provider may request more treatment sessions or days as required. Regardless of PMHM’s authorization with regard to benefit payment, the Provider must provide the amount and type of treatment each patient requires.
In the event that PMHM denies further benefit payments, the Covered Member may initiate an appeal (you may call PMHM to assist the patient in this process). PMHM’s Case Management System has a three-tiered approach, initially using clinical peer review and using independent reviewers at the highest level of appeal. PMHM’s timeliness standards for Clinical Appeals are one (1) business day for expedited appeals and ten (10) business days for standard appeals. In all appeals PMHM requires that the patient’s full medical record be submitted.
For more information about PMHM’s Appeals Process or to initiate an appeal, you may call 800-776-4357.