Partial hospitalization and intensive outpatient services for substance use disorders
Coverage varies by member plan. Medicare Advantage plans don't cover day programs, but may cover components of a day program.
Group HMO, EPO, POS and PPO plans
Individual MyPriority® HMO, POS and PPO 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:
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.
In network providers
Submit authorizations through GuidingCare.
Out of network providers
Out of network providers request mental health and substance use disorder services using our authorization request forms.
- ADHD services
- Autism services
- Coordination of care
- Depression diagnosis and management
- Discharge process
- Electroconvulsive therapy
- Medicaid behavioral health
- Mental health services
- Neuropsych/psychological exams, testing
- Psychological E&M of non-mental-health disorders
- Substance use disorder services
- Transcranial magnetic stimulation