Medicaid behavioral health authorizations
All Priority Health Choice, Inc., members: Medicaid, MIChild, Healthy Michigan Plan
Mild to moderate conditions
Priority Health provides outpatient behavioral health therapy services for Medicaid members with mild to moderate mental health needs. This includes members experiencing or demonstrating mild to moderate psychiatric symptoms or signs of sufficient intensity to cause subjective distress or mildly disordered behavior, with minor or temporary functional limitations or impairments (self-care/daily living skills, social/interpersonal relations, educational/vocational role performance, etc.) and minimal clinical (self/other harm risk) instability.
Request for initial authorization
Effective November 1, 2018, members, who have not received services from local Community Mental Health (CMH), or substance use disorder services, will be initially authorized without a session limit.
Our Behavioral Health team reviews cases of mild to moderate symptoms for clinical appropriateness for services.
Request outpatient services
- Members call Priority Health Behavioral Health Department at 800.673.8043.
- Outpatient providers use the Behavioral Health Outpatient Services Request form and fax to Priority Health.
Severe conditions, substance use disorders, specialized behavioral health services
Medicaid members with severe mental illness (adults), severe emotional disturbance (children), substance use disorders or developmental disabilities, as defined in the Michigan Mental Health Code, should be directed to their local pre-paid inpatient health plan (PIHP) for evaluation and treatment.
Providers are responsible for referring members to their PIHP if they require specialized behavioral health services.
Members who are being served through the PIHP system of care are generally not eligible to receive mental health outpatient services through Priority Health.
Find the correct PIHP
Bill the PIHP in the member's county of residence. The list of all PIHPs and regions can be found here:
The specific code set to be billed to the proper PIHP can be found by logging into CHAMPS:
- Go to the External Links menu located on the 'Provider Portal' page.
- Select 'Medicaid Code and Rate Reference' from the dropdown list.
Below are links to information on substance use disorders and on acute detoxification:
- Medicaid Provider Manual Go to the "Behavioral Health and Intellectual & Developmental Disability Support and Services" section, then Section 1.6, Beneficiary Eligibility
- MDCH Medicaid Mental Health Substance Use Disorder: Inpatient Medical Acute Detoxification
- MSA Bulletin 17-27 Outpatient Behavioral Health Visits
- MSA Bulletin 16-46 Coverage of Trauma Services for Children Under 21 Years
Medicaid eligibility questions
Questions about Medicaid/Healthy Michigan Plan members' service eligibility should be directed to the Priority Health Behavioral Health Department.
Medicaid authorization and payment questions
The Michigan Department of Community Health has created a chart listing authorization and payment responsibilities by type of service and place of service.