Medicaid behavioral health services
All Priority Health Choice, Inc., members: Medicaid, MIChild, Healthy Michigan Plan
Mild to moderate conditions
Priority Health provides outpatient behavioral health therapy services for Medicaid members with mild to moderate mental health needs. This includes members experiencing or demonstrating mild to moderate psychiatric symptoms or signs of sufficient intensity to cause subjective distress or mildly disordered behavior, with minor or temporary functional limitations or impairments (self-care/daily living skills, social/interpersonal relations, educational/vocational role performance, etc.) and minimal clinical (self/other harm risk) instability.
Severe conditions, substance use disorders, specialized behavioral health services
Medicaid members with severe mental illness (adults), severe emotional disturbance (children), substance use disorders or developmental disabilities, as defined in the Michigan Mental Health Code, should be directed to their local pre-paid inpatient health plan (PIHP) for evaluation and treatment.
Providers are responsible for referring members to their PIHP if they require specialized behavioral health services.
Members who are being served through the PIHP system of care are generally not eligible to receive mental health outpatient services through Priority Health.
Download this chart to help you better understand who's responsible for authorizations and payments:
Find the correct PIHP
Bill the PIHP in the member's county of residence. The list of all PIHPs and regions can be found here:
The specific code set to be billed to the proper PIHP can be found by logging into CHAMPS:
- Go to the External Links menu located on the 'Provider Portal' page.
- Select 'Medicaid Code and Rate Reference' from the dropdown list.
Below are links to information on substance use disorders and on acute detoxification:
- Medicaid Provider Manual Go to the "Behavioral Health and Intellectual & Developmental Disability Support and Services" section, then Section 1.6, Beneficiary Eligibility
- MDCH Medicaid Mental Health Substance Use Disorder: Inpatient Medical Acute Detoxification
- MSA Bulletin 17-27 Outpatient Behavioral Health Visits
- MSA Bulletin 16-46 Coverage of Trauma Services for Children Under 21 Years
PHI consent tool
To reduce confusion about when an individuals' consent is necessary to share health information, the Michigan Department of Health and Human Services (MDHHS) has additional resources available, to help clinicians and providers navigate the laws surrounding protected health information (PHI).
There are multiple state and federal laws that address what health information can be shared, when it can be shared and with whom. These resources are intended to increase the flow of patient information from clinician to clinician, particularly in the case of behavioral health information.
Medicaid eligibility questions
Questions about Medicaid/Healthy Michigan Plan members' service eligibility should be directed to our Behavioral Health department. You can reach us at 616.464.8500 during business hours to verify eligibility.
Medicaid authorization and payment questions
The Michigan Department of Community Health has created a chart listing authorization and payment responsibilities by type of service and place of service.
Coordination between PCPs and behavioral health providers
Primary care providers and behavioral health specialists should use the Priority HealthCoordination of Care (COC) form to communicate:
- Requests for consultations
- Medication management or therapy
- Dates of behavioral health sessions
Behavioral health services
- Autism services
- Clinical guidelines
- Coordination of care
- 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