How to Submit a Prior Authorization Request

Applies to: Osmind 360 and Osmind Care Network customers only

If your practice needs Osmind's RCM team to submit a prior authorization (PA) on your behalf, you can do so by submitting a support ticket through the Osmind customer portal. This article walks you through the full process, from logging in to confirming your request was received.

Prerequisites

• You must be an Osmind 360 or Osmind Care Network customer to use this feature.

• You will need the patient's Unique Patient ID, which can be found in the patient's chart under Basic Information.

• Have the following information on hand before starting:

  • Practice name

  • Patient name and Unique Patient ID

  • Service type (e.g., TMS, Spravato)

  • Rendering provider name

  • Procedure code

  • Payer name (e.g., BCBS, Cigna, Aetna)

Clinical Documentation You'll Need to Submit

To support a prior authorization request, gather the following clinical documentation:

For all prior authorizations:

• Confirmed diagnosis of major depressive disorder (MDD)

• Baseline depression severity score using PHQ-9, MADRS, HAM‑D, or QIDS documented at initial evaluation (for TMS, a PHQ‑9 score of 20 or higher, or MADRS score of 35 or higher increases likelihood of approval; payers require this to establish severity and treatment‑resistance)

• Documentation of previous antidepressant trials from different drug classes (preferred), including specific medications, doses, duration of at least 8 weeks, reason for discontinuation, and patient response (Spravato requires 2+ failed trials; TMS requires 1‑2 failed trials)

• All supporting clinical records should be uploaded directly in the patient's Osmind chart before submitting your prior authorization request

• Evidence of patient participation (past or current) in psychotherapy known to be effective for treating major depressive disorder

• Current depression severity scores using PHQ‑9, HAM‑D, or MADRS (for TMS, a PHQ‑9 score of 20 or higher, or MADRS score of 35 or higher increases likelihood of approval)

• Any history of suicidal ideation with intent

• Medical necessity justification

• Documentation that the patient has no contraindications for the treatment

• For Spravato authorizations specifically, you'll also need:

  • Patient current height and weight. When requesting authorization, request 56mg for the first dose and 84mg for all subsequent doses as the standard approach.

  • Confirmed diagnosis of Major Depressive Disorder (MDD)

  • Most recent psychiatric evaluation or intake note

  • Standard treatment protocol documentation: 8 kits in the first 28 days (induction phase with 2 treatments per week), then 4 kits every 28 days thereafter (maintenance phase with once‑weekly treatment, not to exceed 4 treatments within a 28‑day period)

  • Clinical evaluation/Spravato candidacy note

  • Osmind psychiatrist co‑signature (not always required)

  • Prior treatment history as required by the payer

  • Evidence of patient participation (past or current) in psychotherapy known to be effective for treating major depressive disorder (if applicable per payer requirements)

Note: These documents should be submitted together as a complete package. All required documentation must be uploaded in the patient's Osmind chart before submitting your prior authorization request.

Important Insurance Information

Before submitting your request, keep these points in mind:

• Most insurers require that MDD criteria be met before approving treatment

• Some plans require step therapy documentation

• In rare cases, a PCP referral may be required for specialist visits

• Standard PA review timelines are typically 5‑15 business days for Spravato requests, though decisions often come sooner

• Prior approval history does not expedite new PA requests — ongoing patients with previous approvals still follow the same standard review timeline and may require full clinical review

• For Spravato specifically:

  • Spravato 56mg and 84mg doses require separate prior authorizations but your team can submit them at the same time.

Step-by-Step Instructions

Step 1: Log In to the Osmind Customer Portal

Step 1: Log In to the Osmind Customer Portal

Option 1: Direct Portal Login

1. Navigate to the Osmind customer portal login page at support-tickets.care.osmind.org.

2. Enter your email address and click Send Code.

3. Check your email for a one-time login code.

4. Enter the code on the verification screen and click Continue.

Option 2: Access via Osmind Interface

1. Click the "Support ?" option in the bottom left corner of the Osmind interface.

2. Ensure you are logged in to the support portal.

3. Click the purple help button in the bottom right corner.

Step 2: Open the Prior Authorization Request Form

1. Once logged in, you will land on the Issues dashboard.

2. Click Create Ticket in the top right corner, or navigate directly to the prior authorization form via the portal.

3. Under Ticket Form Title, search for and select "Request Prior Authorization".

Step 3: Fill Out the Form

Complete all required fields (marked with an asterisk):

Step 4: Submit the Request

1. Review all fields to ensure accuracy.

2. Click the Submit button at the bottom of the form.

What Happens After You Submit

Once submitted, you will be automatically redirected to the Issues dashboard, where your new ticket will appear under the "On Osmind" section.

You will also receive an automatic confirmation message from the Osmind RCM Team within the ticket, which states:

"We've received your prior authorization request! We will submit and respond here within 2 business days. If you are an Osmind Care Network customer and this PA requires psychiatrist review before submission, please allow us an extra day for that step.

Once on file with the payer, prior authorizations can take up to 5–15 business days to process, depending on the payer. We'll be in touch with you if there are any issues or denials along the way."

— Osmind RCM Team

Key Timelines

• Osmind response time: Within 2 business days of submission (Osmind Care Network customers requiring psychiatrist review should allow 3 business days)

• Payer processing time: 5–15 business days after submission to the payer, depending on the insurer

Tracking Your Request

You can monitor the status of your PA request at any time by:

1. Logging into the Osmind customer portal.

2. Navigating to the Issues tab.

3. Locating your ticket under "On Osmind" (open/in-progress) or "Closed" (completed).

The Osmind RCM team will communicate any updates, denials, or additional information needed directly within the ticket thread.