Optum Behavioral Health Medical Necessity Criteria

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Guidelines/Policies/Manuals - Provider Express

https://www.providerexpress.com/content/ope-provexpr/us/en/clinical-resources/guidelines-policies.html

Optum Extended Outpatient Therapy Supplemental Clinical Criteria: Criteria used to make determinations for Extended Sessions. Optum Quality Performance Tools: Quality tools that annually measure performance against at least two important aspects of each …

Level of Care Guidelines - Provider Express

https://www.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/optumLOCG/locg/StandardLOCG.pdf

o Clinically appropriate for the member’s behavioral health conditions based on generally accepted standards of clinical practice and benchmarks . AND Optum is a brand used by …

LEVEL OF CARE GUIDELINES: SUBSTANCE …

https://www.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/optumLOCG/locg/locgSUD.pdf

The Level of Care Guidelines is a set of objective and evidence-based behavioral health criteria used by medical necessity plans to standardize coverage determinations, …

Behavioral Health Clinical Practice …

https://www.providerexpress.com/content/ope-provexpr/us/en/clinical-resources/guidelines-policies/cpg.html

New: Identification and Management of Eating Disorders in Children and Adolescents (2021) Identification, Evaluation, and Management of Children with Autism Spectrum …

Supplemental Clinical Criteria: Applied Behavior …

https://www.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/bcp/abaAutismSpectrumBCP.pdf

medical necessity and non-medical necessity plans to standardize coverage determinations, promote evidence-based practices, and support members’ …

Clinical Guidelines | UHCprovider.com

https://www.uhcprovider.com/en/policies-protocols/clinical-guidelines.html

This guideline outlines the stages of heart failure and describes a range of generally acceptable approaches for the diagnosis, management and prevention of …

PRP Corner - Optum

https://maryland.optum.com/content/ops-maryland/maryland/en/bh-providers/PRPCorner.html

Behavioral Health Providers PRP Corner - PRP Corner Training Materials Psychiatric Rehabilitation Program (PRP) Minor Functional Impairment Video VIDEO: Psychiatric …

Behavioral Health | UnitedHealthcare Community Plan of …

https://www.uhcprovider.com/en/health-plans-by-state/tennessee-health-plans/tn-comm-plan-home/tn-cp-behavioral-health.html

UnitedHealthcare Community Plan currently utilizes the following Level of Care Guidelines (LOCGs) to conduct medical necessity reviews of requests for services as they apply to …

Maryland Public Behavioral Health System (PBHS) …

https://maryland.optum.com/content/dam/ops-maryland/documents/provider/providermanual/Maryland%20PBHS%20LOC%20Appendix_BH2555_11.19.20.pdf

Qualified Health Center or licensed in accordance with COMAR 10.63 as a substance use, mental health or integrated behavioral health program at the following levels of care: - …

Outpatient Mental Health Center (OMHC) - Optum

https://maryland.optum.com/content/dam/ops-maryland/documents/provider/information/resources/Audit%20Definitions%20Tool_OMHC_TEMPLATE_01.2020.doc.pdf

1. Has the participant or parent/guardian consented to treatment? Accreditation Standard YES / NO document the reasons why the participant cannot give written consent; …

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