Behavioral Health UM & Appeals
Your Partner for Behavioral Health Physician Reviews
The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 requires insurance plans that cover mental health or substance use disorders to offer coverage for those services that is no more restrictive than coverage for medical/surgical benefits. Plans and insurers must disclose detailed criteria for medical necessity determinations relating to mental health and substance use disorders when requested by any current or potential participant, beneficiary, or contracting provider.
More stringent regulations designed to ensure parity for treatment of mental/behavioral health and medical/surgical claims have resulted in a significant increase in the number of mental health and substance abuse claims. This is driving many health plans to offload these reviews to independent review organizations like AllMed. In addition to streamlining health plan operations, AllMed’s MedCert solution helps lower fixed costs, while ensuring the quality and integrity of the physician review process and improving quality of patient care, while controlling overutilization.
AllMed's behavioral health solutions offer:
Reduced cost and achieve organizational streamlining objectives
Optimized work of Medical Directors by focusing them on higher value-added work
Improved ability to handle variable medical review caseloads
Integration with your clinical operations workflow through PeerPoint®, AllMed's state-of-the-art Medical Review Portal
Learn more about how AllMed's Behavioral Health UM program can help your organization streamline your UM process and make objective determinations under tight deadlines.
Contact our team today to discover how outsourcing your behavioral and mental health determinations to AllMed can help your organization achieve detailed, defensible determinations while lowering your fixed costs and decreasing turnaround times.