Policy Updates Medical Policy & Clinical GuidelinesMedicaidJanuary 9, 2024

Mental health provider notification and coordination expectations during urgent care situations

In alignment with our definition of the Medi-Cal Managed Care (Medi-Cal) Urgent Care benefit definition, Urgent Care is not for an emergency or life-threatening condition. It is for services you need to prevent serious damage to your health from a sudden illness, injury, or complication of a condition you already have. Most urgent care appointments do not need pre-approval (prior authorization) and are available within 48 hours of your request for an appointment. Additionally, the Anthem Blue Cross Provider Manual defines Urgent Services as urgently needed services that are covered services and that are not emergency services.

 In general, due to the nature of mental health concerns once deemed urgent, these situations are often viewed as an emergency. Emergency care is for life-threatening medical conditions. This care is for an illness or injury that a prudent (reasonable) layperson (not a healthcare professional) with average knowledge of health and medicine could expect that, if you don’t get care right away, you would place your health (or your unborn baby’s health) in serious danger, or you risk serious harm to your body functions, body organ, or body part.

Psychiatric emergency conditions, such as severe depression or suicidal thoughts, may be covered by county mental health plans. If a member is in need of mental health urgent care (versus emergency care), they are directed to call the county mental health plan or services. To find all counties’ toll-free telephone numbers online, visit dhcs.ca.gov/individuals/Pages/MHPContactList.aspx.

 Regardless of whether the member seeks urgent care or emergency care for their mental health Urgent Care situation, it is essential that the ER or Urgent Care team ensures that the mental health provider of the member is notified during the Urgent Care situation. As part of the evaluation and assessment of the member during their Urgent Care situation encounter, an accounting of current provider shall include identification of current PCPs and providers (including mental health providers and said mental health providers) who shall be coordinated with upon the member’s consent.

 When members are working with Anthem case management teams and the team becomes aware of any recent Urgent Care use from the member or care team, the case management team makes every effort to ensure that the existing mental health provider is notified. 
 
 Anthem additionally has a 24 hour 7 days per week Nurse Line to support members experiencing psychiatric emergencies during non-business hours. Once aware, the Anthem team again coordinates this notification to the existing mental health provider for the member.

 Resources:

  1. Downloadable Anthem Provider Manual:
  2. Downloadable Anthem Member Handbook:

If you have any questions, please reach out to your assigned provider relationship management representative.

Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Blue Cross of California Partnership Plan, Inc. are independent licensees of the Blue Cross Association. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

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