Right Care, Right Time,
- SNP Model of Care
- Cost Containment
- Mental Health Parity
- Care Management Integration
- Programs & Services
- Population Health
- Integrated Case Management
- Synergy Targeted Population Management®
- :: Identify
- :: Engage
- :: Connect
- :: Empower
- :: Impact
- Medical Management
- Behavioral Health Management
Behavioral Health Management
Our line of behavioral health management programs is designed to help expand your portfolio of offerings, drive better clinical outcomes and reduce claims costs. Unlike traditional managed behavioral health care vendors, Health Integrated can easily accommodate clients that need support with only a portion of their behavioral health management services or a complete behavioral health management solution. For example, a client may choose only behavioral health physician review services and some supplemental assistance in the areas of UM and/or CM, or incorporate these into a larger, more comprehensive solution.
All of our behavioral health management offerings are built on years of experience with complex cases involving coexisting medical and behavioral conditions. These services can be implemented on either Health Integrated’s technology platform or on our client’s system, if that’s determined to be a more beneficial approach.
Our Utilization Management team eliminates non-essential treatments and keeps individuals on the path to health by closely monitoring prescribed procedures for medical necessity. Our expert, masters-prepared behavioral health clinicians and nurses work with care providers and plan managers using detailed patient history information, national medical protocols and proprietary behavioral health and psychotropic criteria. Our criteria are based on level of impairment and symptoms, not diagnostic categories, guiding decisions as a psychiatrist would see it. In addition to coordinating approvals for treatment, our team follows up to coordinate continuing or outpatient care after discharge and makes referrals to Case Management where appropriate. Our Utilization Management program is NCQA certified and URAC accredited.
Physician Review Services
Complementing Utilization Management, Health Integrated also offers Physician Review Services. In the instance when a Utilization Management nurse has difficulty reaching a determination of behavioral health necessity, our medical directors are available for additional support, including denials and appeals.
As part of these review services, providers may request a written statement of the
clinical rationale, including the criteria, policy and/or procedure used in making
a medical necessity determination. This information will be available upon request
at no additional charge.
» Request Criteria
Health Integrated provides dedicated coordination for involved psychological and behavioral health cases. Our Case Managers, who are either certified or in training for certification, advocate on behalf of the member to ensure that their treatment is followed and can identify unspecified physical health needs or behavioral health issues. Unique to Health Integrated is our ability to integrate Case Management services for medical and behavioral health, if desired. In addition, we can customize the case identification approach to customer specifications. By operating across multiple organizations, plan programs and benefit providers, our Case Managers ensure awareness of the member’s status, authorizations and care plan. Our Case Management program is URAC Accredited.
After Hours Coverage
For health plans that need 24-hour support for members with respect to behavioral health, Health Integrated provides After Hours Coverage. Our licensed behavioral health clinicians are available to support members with urgent or emergent behavioral health issues 24 hours a day, 7 days a week. This emergency service can help to avert unnecessary hospital admissions and also address the unique safety issues associated with behavioral health.