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

HMSA’s Care Management Services include:

• 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 with 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 certifications decisions have the appropriate training and credentials.