Behavioral health discharge process

To insure that members who are being discharged are receiving follow-up care and contacts in a timely manner:

  • Complete the Priority Health discharge form, not the facility discharge form.
    Discharge from Inpatient Treatment Form
  • Send in the entire form, not just a summary of the information.
  • If the member is discharged early and the facility will not be billing for all authorized dates of service, specify the date range and number of days used during the member's treatment.
  • Fax the discharge information no more than 24 hours or 1 business day after the member exits the facility.

Behavioral health fax process

Send a separate fax for each individual patient. Faxes referencing more than one patient will be returned for resubmission.

  1. Complete the form for the service you're requesting and use it as the cover sheet for your fax.
    Inpatient Prior Authorization Form  or  Outpatient Service Request Form
  2. Identify the evaluating facility/agency contact's name and phone number on the auth form/cover sheet.
  3. Attach complete clinical notes or the screening form to ensure that we have all available clinical data to review.

Requirements for clinical notes

Computer-generated or typewritten notes are preferred. Hand-written documentation may delay the review process and require extra phone calls to clarify information and clinical content. 

Include:

  • CIWA or COWS score if available
  • All vitals including blood pressure, pulse, temperature and respirations
  • Any specific withdrawal symptoms that the patient is currently exhibiting
  • The specific dates of any transfers from one level of service to another

Response turnaround times

We don't typically process requests during the lunch hour, but a requesting facility will receive a response fax within 1 business day.

  • Fax us before 11:00 a.m. - Same-day response
  • Fax us after 2:00 p.m. - Response by 11:00 a.m. next business day
  • Fax us after 4:00 p.m. - Response by 2:00 p.m. next business day

Discharge report questions include:

  1. Initial level of care:
  2. Step-down level of care:
  3. Caller:
  4. Facility information:
  5. Discharge date:
  6. Is the member on medication?
  7. Axis I diagnoses:
  8. Axis II diagnoses:
  9. Axis III diagnoses:
  10. Axis IV diagnoses:
  11. Axis V diagnoses:
  12. Medications; dosage and frequency:
  13. Was there an aftercare appointment set up within 7 days?
  14. Rationale for no aftercare appointment within 7 days:
  15. Member is member being discharged to: partial, intensive outpatient, or outpatient level of care?
  16. Aftercare appointments; provider/facility name(s), location, date(s), time(s):

Go to detailed medical necessity criteria for inpatient psychiatric/substance use and/or partial psychiatric hospitalization.