Behavioral health services
This information applies to:
Commercial group HMO, EPO, POS and PPO plans
Commercial individual MyPriority plans
Priority Health Medicare Advantage plans
Definition
Behavioral health refers to a continuum of services for individuals at risk of, or suffering from, mental, behavioral, or addictive disorders. Services can be offered by a physician, psychologist or other qualified health professional, either in person or via telemedicine.
Coverage varies by provider and type of service.
Specific authorization/billing information
- ADHD care
- Autism services
- Coordination of care
- Depression
- Discharge process
- Electroconvulsive therapy
- Health and behavioral assessments/interventions
- Medicaid behavioral health
- Mental health services
- Neuropsychological vs psychological exams & testing
- Substance use disorder services
- Telemedicine
- Transcranial magnetic stimulation
Medical policies
- Autism Spectrum Disorders – 91615
- Detoxification – 91104
- Eating Disorders – 91007
- Electro-convulsive Therapy (ECT) – 91554
- Mental Health Residential Treatment, Adult – 91608
- Mental Health Residential Treatment, Child and Adolescent – 91607
- Neuropsychological and Psychological Testing – 91537
- Psychological Evaluation and Management of Non-Mental-Health Disorders - 91546
Notify Priority Health immediately
If you identify a member with any one of these indicators, contact Priority Health Behavioral Health immediately.
- Overuse or underuse of medical services
- Non-compliance with treatment plans and/or recommendations
- Complex medical conditions with psychological/behavioral factors
- Complex behavioral health conditions with medical factors
- Inappropriate prescription drug access and use patterns
- Continuity and coordination of care requiring integrated case management
- Significant risk management concerns on cases with both behavioral health and medical factors
To request authorizations
For inpatient, residential and partial hospitalization treatment authorization, concurrent reviews, discharges, etc.:
Call during business hours (8 a.m. - 5 p.m.): Behavioral Health Department, 800.673.8043.
After hours, fax a form to 616.975.0249:
- Behavioral Health Inpatient Authorization Request form
- Inpatient Residential Mental Health request form
For intensive outpatient substance use disorder services:
- Fax the Behavioral Health Outpatient Service Request form to 616.975.024.
- Requests for a stepdown from a higher level of care will be discussed at the concurrent review.