Providers

We are dedicated supporting our providers.

We believe that compassion and consideration is of utmost importance.

Provider Information

Provider information is maintained on a daily basis by the PsycHealth Provider Relations Department.

If you have any questions about the provider information displayed by QC Portal, please contact the Provider Relations Department at [email protected].

Member Eligibility

Please note that Member eligibility information is received on a monthly basis from the medical groups.  As such, there may be a lag of up to 30 days between the time the medical group makes a change to the member’s policy and when that change is reflected by QC Portal.

If you have any questions about the eligibility information displayed by QC Portal, please contact the Clinical Care Department at [email protected].

Provider Information

Provider Notice

All in-network contracted Providers with Holistic PsycHealth. can view and print their Explanation of Benefit reports directly from the secure Provider Portal. Holistic PsycHealth will no longer be mailing these EOBs along with the checks.

Once logged into the portal with your ID and Password, select from the Menu – EOB/Payment History.  You will be able to select the EOB by Payment Date.  Most recent payments are listed first.

If you are an Out of Network Provider, Holistic PsycHealth will continue to mail you your EOBs.

If you have a problem with your ID/Password or any questions regarding this process please send us an email to [email protected]

Providers do not need to wait for mailing of payment to begin posting accounts because EOB are available immediately after printing checks.  As a reminder printing checks is on 15th and 30th (31st).

Holistic PsycHealth utilizes and maintains explicit medical necessity/clinical review criteria that are:

  • based on current clinical principles and practices;
  • and developed with involvement form appropriate providers with current knowledge relevant to the criteria under review.

The 2025 screening criteria to be used for all prospective, concurrent, and retrospective review and case management activities are:

  • Apollo Managing Behavioral Health 2025 for medical necessity determinations;
  • and ASAM Criteria for Substance Use Disorder Determinations fourth edition, 2023.

Upon request to the Quality Improvement or Clinical Department providers may obtain a copy of any criteria utilized in making a medical necessity determination. Providers can send requests to [email protected]

Providers have the ability to request case management and complex case management services for their members through the [email protected] or over the phone.

Referral and Authorization requests are reviewed on a daily basis by the Holistic PsycHealth.  The current status of any request can be viewed via the Provider Portal.  All referral and authorization requests will be processed in accordance with terms set forth in the Holistic PsycHealth Provider Contract.

If you have any questions about the status displayed by QC Portal, please contact the Utilization Management Department at [email protected].

Holistic PsycHealth. has ongoing quality programs and initiatives.  These are reviewed each year.  The reviews let us see what we are doing right or what we can do better.  We also look at complaints and satisfaction of our providers and members.   For more information, contact Holistic PsycHealth at 847-864-4961

Annually the Holistic PsyHealth Peer Review Committee:

  • Adopts the latest edition of the American Psychiatric Association Practice Guidelines
  • Identifies three practice standards for assessment of performance measurements.
    • ADHD
    • Schizophrenia
    • Depression

Claims submissions are reviewed on a bi-weekly basis by the Holistic PsycHealth Claims Department.  The current status of any claim processed by Holistic PsycHealth can be viewed via the Provider Portal.  All claims submissions will be processed in accordance with Illinois law and Holistic PsycHealth claim policies and procedures.

If you have any questions about the status displayed by Provider Portal, please contact the Claims Department at [email protected].

From time to time, Holistic PsycHealth will use the System Messages to convey important information to providers.  Please review the messages on this screen as they may indicate when Provider Portal may be unavailable for use due to system maintenance and/or upgrades.

The Provider Portal is an internet based application and is subject to occasional outages.  If the Provider Portal website cannot be reached for any reason please contact us so we may resolve the issue. Please note that most outages are resolved within 24-hours.

Provider Portal

The Provider Portal, also known as QC Portal, is a comprehensive managed care software that is highly flexible, easy to use and powerful. The software allows PsycHealth providers to verify eligibility, enter referral and authorization requests, submit claims and view the status of all data in real-time from any internet web browser. It is secure and HIPPA compliant for submitting supporting clinical information and documents.

Claim History and Submission

QC Portal additionally allows for viewing claim history and submission of manually entered claims and 837 EDI files.

Member Eligibility

QC Portal uses real-time data to search and preview member eligibility.

Referral History

QC Portal allows for searching for outpatient mental health service records.

Authorization History

QC Portal also can display authorization history, including inpatient, partial, and intensive outpatient mental health service records.