Important Prior Authorization Changes

As 2009 approaches, we would like to remind you that outpatient mental health and substance abuse therapy sessions do not require prior authorization.

This means that you will not need to call us to approve outpatient mental health or substance abuse therapy sessions for 2009. Please note that Priority Health members are still required to obtain prior authorization for initial evaluations for counseling, psychological testing and psychiatric medication management. In addition, authorization is not needed beyond the initial evaluation for psychological testing, psychiatric medication management and substance abuse intensive outpatient therapy.

Priority Health has also made two changes to our inpatient authorization processes that will positively impact your facility. Both changes became effective November 1, 2008.

1. We will no longer require prior authorization or management of intensive treatment admissions for members with traditional Medicare as their primary coverage, and a commercial Priority Health product as secondary. This means you will not need to call us to approve admissions or request additional days for inpatient, partial, detoxification or rehab levels of care. Please note that this does not apply to members with PriorityMedicare^SM. We will continue to require prior authorization and management for these members.
2. We will no longer require you to complete concurrent reviews for intensive levels of care (inpatient, partial, detoxification, rehab, etc.) on weekends. All utilization management will occur during our regular business hours – 8:30 a.m. to 5 p.m., Monday through Friday.

Authorization is needed for mental health intensive outpatient, inpatient (with the exclusion of the above mentioned information), partial hospitalization, sub-acute detoxification, ECT (outpatient/ inpatient), OPR or non-participating provider authorizations for all levels of care.