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

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:

For intensive outpatient substance use disorder services: