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HealthPartners

Coverage criteria policies

Inpatient - behavioral health coverage criteria

These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

  • Notification is required for all inpatient Mental Health admissions.
  • Concurrent review is required for inpatient treatment at a non-contracted facility.
  • For concurrent review, please contact the Behavioral Health Department at 952-883-7501 for authorization or fax clinical to 952-853-8830

Coverage

HealthPartners follows the MCG Behavioral Health Care Guidelines 22nd edition. Please contact the Behavioral Health Department at 952-883-7501 for a copy.

Indications that are not covered

  1. Services for concurrent care that do not meet the Milliman Care Inpatient Behavioral Health Level of Care.
  2. Member’s plan does not cover services requested.

Definitions

Inpatient Care: This is a medically necessary continuous confinement in a hospital lasting 24 hours or more that includes charges for room and board and provides 24 hour nursing for the acute care of a mental health diagnoses as described in the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM 5) (most recent edition) that leads to significant disruption of functioning or becoming a threat to self or others.

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.

References:

  1. MCG Behavioral Health Care Guidelines 22ndst edition, Inpatient Behavioral Health Level of Care, Child or Adolescent & Inpatient Behavioral Health Level of Care, Adult

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Policy activity

  • 01/01/2001 - Date of origin
  • 05/08/2018 - Effective date
Review date
  • 02/2018
Revision date
  • 05/08/2018

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