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, or a post payment appeal determination, you may need to send us medical records.
To submit medical records for a specific claim (post-claim):
- Find the claim online using the Claims tool
- From the remittance advice (claim detail) screen, click Contact us
- In the drop down menu, select Medical records
- Attach medical records to your message.
You'll receive a confirmation screen after submitting your message, and a confirmation email from our Provider Services team.
To submit medical records that are not related to a specific claim (pre-claim):
- Go to your Priority Health Secure Mailbox.
- Click the Compose tab
- In the What is your message about? field, choose Medical record submission (pre-existing)
- Use the Attachments field to attach your documents
- In the body of the email include: member name, DOB and member ID number.
- If you are submitting a pre-claim 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.