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(641) 856-2688 info@paulagordy.com Fax: (641) 856-2690

BHIS Referral

Refer a child, teen, or adult for Behavioral Health Intervention Services in southern Iowa.

Behavioral Health Intervention Services

Making a BHIS Referral

Behavioral Health Intervention Services (BHIS) are skills-based mental health services funded through Iowa Medicaid and delivered where the client lives, learns, and spends time — at home, at school, in the community, or at one of our offices. Use the form below to refer someone to our BHIS program.

Who Can Submit a Referral?

Anyone involved in the client's care may submit a BHIS referral to our practice, including:

  • Parents and legal guardians — self-referrals for your own child are welcome and are one of the most common ways families start
  • School staff — counselors, social workers, principals, and AEA staff
  • Medical providers — primary care physicians, pediatricians, ARNPs, and psychiatric prescribers
  • Mental health providers — therapists and agencies coordinating a client's care
  • Iowa HHS, case managers, and juvenile court services
  • Adults referring themselves for their own services

Who Qualifies for BHIS?

BHIS is generally available to individuals who:

  • Have a qualifying mental health diagnosis, or need an assessment to determine one
  • Are enrolled in Iowa Medicaid through Wellpoint Iowa, Iowa Total Care, or Molina Healthcare
  • Have functional difficulties at home, at school, or in the community related to their mental health

Not sure whether someone qualifies? Submit the referral anyway. Determining eligibility is part of the assessment, and you do not need to work it out in advance.

What Happens After You Submit

Step 1

We Review the Referral

Our team reviews every referral and confirms we have what we need to move forward. Referrals are reviewed during regular business hours.

Step 2

We Contact the Family

We reach out to the parent, guardian, or client within 1–2 business days to verify Iowa Medicaid coverage and answer questions.

Step 3

Mental Health Assessment

A licensed clinician completes an assessment to establish the diagnosis and determine whether BHIS is the right fit.

Step 4

Treatment Plan & Services Begin

We build an individualized treatment plan with the client and family, then BHIS services begin in the agreed-upon settings.

Submitting a referral does not begin services. Eligibility for BHIS is determined through a mental health assessment and Iowa Medicaid criteria. We will always contact the parent, guardian, or client before any services are scheduled.

Secure Submission

BHIS Referral Form

Fields marked with an asterisk are required. If you do not have a piece of information, leave it blank and we will follow up.

This form is not for emergencies. If someone is in immediate danger or experiencing a mental health crisis, call 911 or call or text 988 (Suicide & Crisis Lifeline). Referrals submitted here are reviewed during regular business hours only.

About your information: This form is transmitted over an encrypted connection and delivered directly into our practice's HIPAA-covered email environment under a signed Business Associate Agreement. It is used only to review the referral and contact the client or guardian. Please share only what is relevant to the referral.

1. About You (Referral Source)

2. Client Information

If the client is under 18, please complete the parent or guardian details below. This is who we will contact first.

3. Iowa Medicaid & Insurance

We verify coverage before services begin.

4. Reason for Referral

A diagnosis is not required to refer. The assessment establishes it.
If there is an immediate safety risk, call 911 or 988 instead of waiting on this referral.

5. Services Requested

6. Authorization

We review referrals during regular business hours and typically make contact within 1–2 business days. Questions? Call (641) 856-2688.

Alternatives

Other Ways to Submit a Referral

If you would rather not use the online form, any of these work just as well.

Call the Office

Speak with our administrative team and give the referral over the phone.

(641) 856-2688

Fax a Referral

Schools, clinics, and agencies can fax referral paperwork directly to the office.

(641) 856-2690

Forms & Documents

Intake paperwork and other practice forms are available to complete ahead of time.

View forms

Questions About BHIS?

If you are not sure whether BHIS is the right fit, a short phone call is the easiest place to start. Our team can walk you through eligibility, coverage, and what services look like week to week.

Call (641) 856-2688 Learn About BHIS Parent's Guide to BHIS