HMSA’s Managed Behavioral Health Program helps ensure your employees and their family members will be referred to the appropriate level of care. Through a comprehensive assessment, HMSA’s counselors determine the current treatment needs of the employee/family member and refer to a provider specializing in that treatment. By utilizing a managed care program, HMSA is able to reduce unnecessary treatment costs by facilitating services from beginning to end. HMSA manages 100 percent of all levels of care from pre-certification and referral to on-going authorizations and discharge planning.

HMSA’s Managed Behavioral Health program includes:

• Pre-certification of all higher levels of treatment
• Concurrent review of all higher level of treatment cases
• Discharge planning for all higher level of treatment (including outpatient follow-up appointments within seven days of discharge)
• Intensive Case Management (ICM) with high risk cases to identify and reduce risks, reduce barriers to treatment and optimize recovery

A written appeal process will be initiated in the case of a denial of authorization for requested services. All individuals responsible for managing the appeals of decisions have the appropriate training and credentials.