Prior authorization for behavioral health visits removed
Effective July 1, 2010, prior authorization is not required for behavioral health office visits for initial evaluations or emergent evaluations.
- This change applies to all commercial and self-funded plans.
- This change does not impact Medicare, prior authorization has not been previously required.
- Prior authorization is required for members with Priority Health Medicaid for outpatient services.
Providers or members do not need to call for prior authorization when seeing a Priority Health participating provider for:
- Initial evaluations for mental health and substance abuse counseling
- Initial evaluations for medication management
- Health and behavior intervention procedures
- Psychological testing
- Neuropsychological testing
- Ongoing treatment:
- Mental health and substance abuse outpatient counseling
- Psychiatric medication management
- Mental health and substance abuse group counseling
- Substance abuse intensive outpatient services
Prior authorization should continue to be obtained for certain services by:
- Facilities prior to admitting a member for inpatient or partial-hospitalization psychiatric and substance abuse care.
- Mental health agencies and outpatient facilities prior to providing intensive outpatient mental health care.
Details are available
online.
- Select “Behavioral Health” to find a link entitled: “Who is responsible for getting BH authorizations from Priority Health?”
- Select “Medical Policies” for specific treatment authorization requirements.
If you have questions, please contact our Behavioral Health department at 800 673-8043.
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