Behavioral Health

Case management and review services are provided through HMSA's behavioral health services. It is a progressive, data-supported approach to delivering behavioral health care benefits built on a population-based, disease management model.

Program highlights include:

• More choices for HMSA members: HMSA’s PPO and HMO members have access to HMSA’s entire network of participating mental health and substance abuse providers. QUEST members will use the existing QUEST network of providers.
• Simplified administrative procedures: For most HMSA plans, precertification is no longer required for inpatient visits or referrals. Professional services rendered to HMSA PPO and HMO members will be paid based on HMSA’s eligible charge. Professional services rendered to QUEST members are based on the QUEST fee schedule.
• Intensive case management: HMSA will work with the patient and their family, providers, and community resources to provide case management for high-risk patients with behavioral conditions or a combination of behavioral and medical conditions.
• Meaningful feedback: Using a data-supported and population-based approach, HMSA provides feedback through reports to providers, which can be used to help determine appropriate patient interventions.

Refer to the Behavioral Health main page for related information.

Various materials from behavioral health services are available as PDF files:

• Participating Provider Directory for Autism Spectrum Disorder

Revision History