Coordination of care
Notify Priority Health immediately
Should you identify a member with one of these indicators, contact 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
Coordination between PCPs and behavioral health providers
Primary care providers and behavioral health specialists should use the Priority Health Coordination of Care (COC) form to communicate:
- Requests for consultations
- Medication management or therapy
- Dates of behavioral health sessions
Using the Coordination of Care form
- To request information: complete Sections 1-5.
- To provide information: complete Sections 1, 4 and 6.
- Mail the original and keep a copy for your records.
Section 1: Patient information
Complete all fields.
Section 2: Reason for referral
Identify the reasons why you are referring the patient to another provider. Check all boxes that apply.
Section 3: Indicators
Identify what conditions have been affecting the patient's emotional and physical health. Check all boxes that apply.
Section 4: Service requested
Select the treatment/service the practitioner can provide:
- One-time consultation
- Consultation and co-management of the patient
- Manage the patient's treatment
- Manage medications
- None - communication only (when the form is being used solely for communication)
Section 5: Response requested
Designate the type of response you would like from the practitioner. For example:
- Practitioner's findings or recommendations based on the consultation (all documentation should be attached)
- Dates of the behavioral health sessions
- Written notes and a phone call to further coordinate care
- Referral communication (indication that patient has contacted or scheduled an appointment with the practitioner)
Section 6: Response
(For responding provider use only)
- Complete if you receive the COC form.
- Record your findings or treatment recommendations.
- If dates of behavioral health sessions are requested, provide the dates of two sessions that occurred after the original requested date.
- If you need more room, indicate you are continuing your statement either on the back of the form or on an attachment.
- Sign and date the form.
For Office Use Only:
Sent/Referred to: Print the name of the receiving practitioner and the referral date
Sent/Referred by: Use when identifying the date and office personnel sending the form.
Behavioral health services
- 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