Substance use disorder treatment authorizations
Behavioral health fax process
Send a separate fax for each individual patient. Faxes referencing more than one patient will be returned for resubmission.
- Complete the form for the service you're requesting and use it as the cover sheet for your fax.
Inpatient Prior Authorization Form or Outpatient Service Request Form
- Identify the evaluating facility/agency contact's name and phone number on the auth form/cover sheet.
- Attach complete clinical notes or the screening form to ensure that we have all available clinical data to review.
Requirements for clinical notes
Computer-generated or typewritten notes are preferred. Hand-written documentation may delay the review process and require extra phone calls to clarify information and clinical content.
- CIWA or COWS score if available
- All vitals including blood pressure, pulse, temperature and respirations
- Any specific withdrawal symptoms that the patient is currently exhibiting
- The specific dates of any transfers from one level of service to another
Response turnaround times
We don't typically process requests during the lunch hour, but a requesting facility will receive a response fax within 1 business day.
- Fax us before 11:00 a.m. - Same-day response
- Fax us after 2:00 p.m. - Response by 11:00 a.m. next business day
- Fax us after 4:00 p.m. - Response by 2:00 p.m. next business day
- BH auth criteria
- Mental health treatment auths
- Substance use disorder treatment auths
- Discharge process
- Medicaid BH authorizations
Submitting medical records
When you request an authorization, an informal coding review or a post payment appeal determination, you may need to send us medical records.Use your secure mailbox to send the forms to us via email or mail us a hard copy. To access your secure mailbox:
- Go to your Priority Health account Mailbox.
- Click the Compose tab.
- In the "What is your message about?" field, choose Medical record submission.
- Use the Attachments field to browse to your documents and attach them.
- In the body of the email include: member name, DOB, member ID number, and inquiry number, if you have one.
- If you are submitting an appeal; you must complete and attach the most current Priority Health appeal form and submit a detailed letter of appeal. For more information on appeals access our Reviews and appeals requirements.
If you don't have a Priority Health provider account, request one now.