Requesting behavioral health authorizations
Members do not need a direct referral from their PCP for behavioral health services. In fact, in some cases, we prefer that members call for authorizations.
A primary care physician can call Priority Health Behavioral Health to request an authorization, but the member may still be required to contact us for referrals for certain services.
Refer to this list to see who is responsible for getting specific authorizations. Call Priority Health Behavioral Health for more information.
| Who should request the authorization? |
|---|
| Treatment |
Member requests |
Provider requests |
Comments |
Initial evaluation for routine outpatient mental health and substance abuse services
|
|
|
No authorization is needed
|
Initial evaluation for inpatient psychiatric or substance abuse services
|
|
|
No authorization is needed
|
| Emergency services |
X |
X |
Call Behavioral Health 24 hours a day to speak with a case manager who can direct you to emergency services and/or urgent care. |
| Hospital and program services |
|
X |
Providers must call Behavioral Health to request authorization for admission to:
- An inpatient facility
- A partial hospitalization program
- An intensive outpatient program
If additional hospitalization or treatment days are recommended, the attending physician or a designee must call Priority Health to obtain authorization. |
| Discharge planning |
|
X |
- Behavioral Health providers must schedule a follow-up appointment with a mental health and/or substance use provider for the patient no more than 7 days following discharge from a higher level of care in a psychiatric or substance use facility.
- Contact our Behavioral Health staff with any questions or needs. Clinical case managers are available to work with hospitals, facilities and treatment programs to assure a smooth transition to a lower level of care and to assist patients arrange their follow-up services.
|
| Pain management |
|
|
Members or providers can call the Behavioral Health Department for pain management services referrals. |
| Medication management |
|
|
Members or providers can call Behavioral Health to request referrals for medication management services.
|
Child and adult ADHD assessments
|
|
|
Outpatient child and adult ADHD testing by a fully licensed psychologist is generally covered under the mental health benefit.
|
| Electroconvulsive therapy (ECT) |
|
X
|
- Prior auth is not required for outpatient ECT, except for non-contracted facilities.
- Prior auth is required for inpatient ECT.
- Providers can call Behavioral Health and a benefit coordinator will check the member's coverage documents for appropriate coverage and authorize ECT sessions based on medical necessity.
|
| Neuropsychological testing |
|
|
Neuropsychological testing is a medical benefit and not authorized by the Behavioral Health department. Requests for neurological testing when a definitive organic condition is present will be referred to the member's health plan or PCP. |
