Mental health treatment authorizations
For specific information on authorization and billing for mental health services, see these pages under Procedures & services > Behavioral health > Mental health services:
See the Approved Drug List for information on how medications used to support mental health are covered.
In network providers
In network providers can request authorization for mental health and substance use disorder services, evaluations and discharges using the GuidingCare.
Out of network providers
Fax behavioral health concurrent review requests with clinical documentation from the current day. Use the applicable authorization form as your fax cover sheet and fax to 616.975.0249.
Denials and peer reviews
The assigned Priority Health utilization management (UM) care manager calls the facility UM reviewer to let them know if/when we are initiating a physician advisor review.