Enhancements to Behavioral Health Services

Date: 01/18/19

In November 2017, Superior HealthPlan began managing Behavioral Health (BH) services, mental health and substance use disorders for our members. Since this transition began, Superior’s BH Utilization Management (UM) team has focused on streamlining processes and improving the provider’s experience with UM processes.

The goals of BH UM are to provide covered services that are medically necessary, appropriate to the member’s condition, rendered in the appropriate setting and meet professionally recognized standards of care. In order to ensure providers can assist our members with BH services, the BH UM team strives to reduce the administrative burden for providers and create a consistent approach towards achieving quality health-care outcomes for our members.

To achieve these goals, Superior has implemented the following:

SUPERIOR ENHANCEMENTS TO BH SERVICES
	Direct Access for Providers Established a dedicated BH Utilization Management team to assist providers and streamline the inpatient notification and authorization request. Allows providers to easily request and access authorization information. Allows providers be transferred to clinical staff using a dedicated phone number by calling 1-844-842-2537, or obtain authorization using a direct fax line at 1-866-900-6918. Streamlined the BH retrospective review process, which further improved the timeliness of authorization reviews. Aligned the BH notification process to help with efficiency and decrease the need for after-hours notifications. Re-located our BH prior authorization forms to Superior’s BH webpage to ensure providers can easily access information needed for treatment requests.
	BH Clinical Utilization Managers Improved the ability to directly contact a BH Utilization Manager for concurrent review. Increased the ability to directly transfer providers to clinical staff when necessary. Shifted from retrospective concurrent reviews to prospective concurrent reviews.
	Medical Director Reviews Increased the number of BH Medical Directors, which has decreased the use of external reviewers. Improved the peer-to-peer process, which includes the ability to schedule a peer-to-peer review, resulting in a more efficient process for providers.
	A Centralized Appeal Process Created a dedicated, centralized BH appeals team within Superior’s UM Appeals Team. Revision of the BH appeal processes, aligning with Superior’s standardized appeals processes.

Superior continuously reviews policies and procedures to ensure quality care is delivered to members and provider needs are met. During reviews, provider feedback is crucial to making informed decisions on changes that need to be implemented. Along with the changes mentioned above, provider feedback has also influenced several initiatives to improve provider experience that have resulted in direct changes in Superior policies and procedures in 2018. Please review the following article for more information: Provider Feedback Creates Changes at Superior

For questions or more information, please contact your dedicated Account Manager.