Ohio Utilization Management for Specified Community Mental Health Medicaid Services (Ohio CMH)
Introduction
Health Care Excel, under the direction of the Ohio Department of Mental Health, performs prior authorizations for Partial Hospitalization (PH) and Community Psychiatric Supportive Treatment (CPST) to evaluate the medical necessity of treatment for both kids and adults who need services beyond the benefit limit.
Ohio-licensed clinical reviewers evaluate prior authorization requests using an established and approved set of medical necessity criteria. When clinical information supports the need for continued services, an approval is rendered. If the clinical information provided does not support the need for additional treatment, the case is deferred to an Ohio-based, board certified psychiatrist for review.
Before a recipient reaches the service limits for either PH or CPST services, a Prior Authorization (PA) for continued services must be obtained.
Health Care Excel staff are available to answer technical and clinical questions about the Prior Authorization Process as well as provide telephonic and on-site education. Please contact Ohio Community Health staff for any questions at 1-888-239-7758 or e-mail OhioCMH@hce.org.
Ohio CMH Resources
Health Care Excel and Ohio Department of Mental Health Training Power Point Presentations October and November 2011
- Introduction to the Prior Authorization Process (Presented by Health Care Excel staff)
- Budget Overview and Office of Health Integration 2013 Work Plan (Presented by Terry R. Jones, LISW-S, Manager of Program compliance)
- Community Mental Health Medicaid Benefits (Presented by Kathy Cluggish, Macsis Support Desk Supervisor)
- Provider Web Portal (Presented by Kathy Cluggish, Macsis Support Desk Supervisor)
Additional Resources
- Ohio CMH On-Line User Registration
- Ohio CMH Agency Contact Registration Form
- Ohio CMH Prior Authorization Form
- Ohio CMH QUESt
Ohio CMH Provider Handbook
- Overview of Prior Authorization Process
- Medical Necessity Criteria
- Exemptions to Prior Authorization
- Units of Service and Retro Authorization Requests
- Prior Authorization Process
- Appeal Process
- Prior Authorization Form
- Submitting prior Authorization Requests
- Contacting Health Care Excel
- Contacting State Agencies and resources
- Recognized Holidays
- Glossary of Terms
