Partial hospitalization authorizations for mental health services
Coverage varies by member plan.
Group HMO, EPO, POS and PPO plans
Individual MyPriority® HMO, POS and PPO plans
Medicare Advantage plans
The term "medical necessity" is used to mean care that is determined to be effective, appropriate and necessary to treat a given patient's disorder. To determine medical necessity for partial hospitalization and intensive outpatient treatment, the Priority Health Behavioral Health department relies on InterQual® Behavioral Health criteria and Priority Health medical policies:
Medical Necessity - 91447
Authorization is required
Members/participants/beneficiaries must meet InterQual® Behavioral Health medical necessity criteria for partial hospitalization and intensive outpatient programs.
You must request authorization prior to sending a member to these programs.
We also require ongoing clinical reviews to ensure that the member continues to meet medical necessity criteria for treatment.