Change to behavioral health immediate reconsideration reviews
Beginning August 31, we will no longer accept immediate reconsideration reviews for behavioral health appeals.
You should follow the standard reviews and appeals process to reconsider coverage and payment.
We will discontinue verbal offer of immediate reconsideration reviews to behavioral health providers. If a provider requests an immediate reconsideration review, clinical staff will respond with the following information:
- The immediate reconsideration review process will be discontinued effective August 31, in effort to improve efficiencies, fully align and integrate with the medical division’s robust Utilization Management (UM) program and ensure compliance with our NCQA accreditation.
- Providers are not losing an opportunity for a review. We are aligning our practices with medical determinations and appeals.
Why are we making the change?
The immediate reconsideration review practice no longer aligns with Priority Health’s robust UM program. In order to continue to improve efficiencies, advance physical health integration, and ensure compliance with our NCQA accreditation, we are removing this outdated practice.