Behavioral health utilization decisions
In order to serve the best interests of our members, Priority Health will make utilization decisions that are fair and consistent by doing the following:
- Making utilization decisions based only on appropriateness of care and service, as well as existence of coverage
- Not compensating or rewarding practitioners or other individuals conducting utilization review for denial of coverage or service
- Not offering financial incentives for utilization decision-makers to encourage denial of coverage or service
- Deciding on coverage of new technology after comprehensive research and careful review by our board-certified psychiatrists
- Providing information about the utilization management process and the authorization of care
If you have a question regarding general or specific utilization management decisions or processes, please contact the Behavioral Health department at 616 464-8500 or 800 673-8043. In addition, the medical necessity criterion is available online.
Topics: Utilization management
