Behavioral Health Forms

This page contains Behavioral Health forms for providers to use when communicating with Highmark Blue Shield of Northeastern New York.

Residential Treatment Center (RTC) must be accredited by a nationally recognized organization and licensed by the state, district, or territory to provide residential treatment for medical conditions, mental health conditions, and/or substance abuse. 

Pre-Admission Requirements:

  • Precertification prior to admission
  • A preliminary treatment plan and discharge plan must be developed and agreed to by the member, provider (residential treatment center (RTC), and case manager in the Local Plan where the RTC is located prior to admission.
  • Member must be enrolled and participating in case management through the Local Plan when the care is medically necessary for treatment of a medical, mental health, and/or substance abuse condition.

FEP Nondiscrimination Notice

Last updated on 6/19/2023 1:50:39 PM


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