Do services need to be pre-authorized/pre-certified?

All EAP services and higher levels of care must be pre-authorized by Quest, with the exception of inpatient psychiatric consults on medical/surgical floors. Inpatient psychiatric consults can be called in the next business day.

Does the patient need a referral from a Primary Care Physician?

Patients do not require a referral from the PCP. For the benefit of the patient, Quest encourages ongoing communication with the primary care physician regarding the treatment of members in behavioral health.

How do I find out my patient's benefits?

Any provider may contact Quest to find out who is the benefit administrator. If we are the benefits administrator, any of our clinical and customer service team can assist you.

What is the protocol for submitting a claim?

Enrollees' claims should be submitted to the benefit's claims processor directly. If we are the claim's processor, a standard HICFA or UB-90 form can be used. They should be sent to: Quest Behavioral Health, PO Box 1032, York, PA 17405-1032.

How do I contact Quest if I have questions regarding a claim?

You may contact our business office by our toll free line 800.364.6352, email at claims@questbh.com, or write us at our above address.

What is the payment if Quest is the secondary insurance?

If we are the secondary insurance to other coverage, your reimbursement is limited by your contractual relationship with both insurances. You are required to stay within the boundaries of the primary insurance. Quest requires an EOB (explanation of benefits) from the primary insurance to be able to process the claims.

If a new clinician begins employment at a participating facility/group/practice, when will they be able to see Quest members?

New clinicians may either contact the Provider Relations Dept at 800.364.6352 or submit a provider pre-application to begin the credentialing process. Every licensed clinician is required to be individually credentialed and approved by the Quest Credentialing Committee before being able to see patients. This process can take 1-3 months so a provider office may decide to start this process prior to the clinicians first day.