Behavioral health authorization process changes

Blue Cross Blue Shield of Michigan is changing the behavioral health authorization process to assure alignment with the federally mandated mental health parity regulations. MHP regulations require that the rules governing behavioral health and substance abuse services are no more stringent than those applied to medical services.

As you may know, Magellan Behavioral of Michigan, Inc. manages the Blue Cross review process for psychiatric inpatient and partial hospitalizations and hospital-based substance abuse admissions.

The changes to the behavioral health authorization process apply to all psychiatric facilities and hospital-based substance abuse facilities that provide inpatient services to BCBSM members.

Keep in mind that the changes impact Blues members with either Blue Traditional or PPO coverage. They do not apply to customer groups that have chosen a third party to administer their behavioral health benefits. Also, they do not currently apply to freestanding substance abuse facilities.

In addition, select Blue Choice PPO and Federal Employee Program^® members are exempt from the fax notification process. These members will continue to require precertification and recertification by phone beginning day one for admissions that require authorization.

Changes effective for admissions on or after Sept. 1
To align behavioral health and medical authorization practices, the following authorization rules will be consistently applied to all facilities required to obtain authorization for inpatient behavioral health services:

• There will no longer be a facility designation program for behavioral health.
• All inpatient behavioral health facilities will be required to fax a notification form for all admissions and discharges.
• All inpatient behavioral health facilities will be required to fax, email or call for clinical review through discharge for all admissions exceeding four days.
• Non-acute day assessments for the purpose of establishing designation status will no longer be conducted. BCBSM retains the right to audit any service to determine medical necessity or appropriateness.

Facility Admission, Recertification and Discharge Notification Form
Facilities will continue to be required to use this form for patient admissions and discharges.

• Fax the form to Magellan at 1-888-656-1637 within 24 hours of an admission.
• When a patient’s hospital stay is four days or fewer, the facility must fax the discharge information on the same form to Magellan within 24 hours of discharge.
• If the length of stay exceeds four days, the facility is required to fax, email or call Magellan for a clinical review on day five of the admission. (Use the form when faxing or emailing for recertification.)
• Fax: 1-888-656-1637
• Email: BCBSMNotification@MagellanHealth.com
• Phone: 1-800-762-2382.

Upon discharge, the facility must fax the discharge information on the form to Magellan within 24 hours of discharge.

• If a member is admitted to a partial hospitalization program following an inpatient admission, the facility must fax, email or call for clinical review at admission.

The form is accessible online on web-DENIS. The form includes submission instructions. To download the form:

• Log in to web-DENIS.
• In the left-hand navigation area, click on BCBSM Provider Publications and Resources.
• Click on Newsletters & Resources.
• Under “Other Resources,” click on Clinical Criteria & Resources.
• In the right-hand column under “Frequently Used Forms,” click on the Facility Admission, Recertification and Discharge Notification Form. If you have other questions about behavioral health admissions, call Magellan at 1-800-762-2382.