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Mental health residential treatment authorizations

Page last updated on: 8/27/26

Coverage varies depending on plan

Applies to:

Group HMO, EPO, POS and PPO

Individual MyPriority HMO, POS and PPO

Eating Disorder and Mental Health Residential Treatment Authorization Assistance

Due to limited availability of eating disorder and mental health residential treatment facilities in Michigan, behavioral health providers requesting authorization on behalf of insurance members are encouraged to contact the Behavioral Health Department at 800.673.8043 for assistance with care coordination, access, and benefit review.

Our team can help confirm residential treatment benefits and available network options, including access to Cigna’s national network when applicable and consistent with authorization requirements.

Residential treatment requires 24-hour on-site nursing (RN/LVN/LPN) and 24-hour on-call physician, physician's assistant, advanced practice registered nurse, registered professional nurse or licensed practical nurse under the supervision of a registered professional nurse or physician available to be on site within 30 minutes or notification of emergent health concern. 

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 mental health residential treatment, the Priority Health Behavioral Health department relies on InterQual® Behavioral Health criteria and Priority Health medical policy:

Criteria required for initial and concurrent medical necessity reviews includes but not limited to:

  • Chronic medical conditions
  • Stressors/symptoms
  • Psychosocial information
  • Psychotropic medications
  • Pertinent treatment history
  • Risk factors

Authorization is required. In addition to the member meeting medical necessity criteria, the residential program must meet our Residential Facility criteria. We also require ongoing clinical reviews to determine if the member continues to meet medical necessity criteria for treatment.

In-network providers

In-network providers can request authorization for mental health and substance use disorder services, evaluations and discharges using GuidingCare.

Request an authorization

Out of network providers

If you’re a provider located within the state of Michigan and would like to join our network, visit our credentialing application page.

Out-of-network providers request mental health and substance use disorder services using our Behavioral Health Authorization Form.