Coverage varies by member plan.
Applies to:
Group HMO, EPO, POS and PPO plans
Individual MyPriority® HMO, POS and PPO plans
Medicare Advantage plans
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 substance use disorder detox the Priority Health Behavioral Health department relies on InterQual® Behavioral Health criteria and Priority Health medical policies:
Members must meet InterQual® Behavioral Health medical necessity criteria for urgent/emergent admission to a substance use disorder facility.
We also require ongoing clinical reviews to ensure that the member continues to meet medical necessity criteria for treatment.
Submit authorizations through GuidingCare.
Out of network providers request mental health and substance use disorder services using our Behavioral Health authorization form. If you're located within the state of Michigan and would like to join our network, visit our credentialing page.
We also require ongoing clinical reviews to determine if the member continues to meet medical necessity criteria for treatment.