PMHM Comprehensive (Outpatient & Inpatient Behavioral Management)
For the ultimate in treatment quality and cost effectiveness, PMHM Comprehensive is a full behavioral managed care program for both outpatient and inpatient care. PMHM Comprehensive includes the following:
Outpatient Assessment & Referral. When a member requires services, he or she calls PMHM’s toll free helpline. The helpline is manned 24 hours a day and 7 days a week. During the call, the patient initially speaks with a PMHM Patient Relations Coordinator (PRC) who explains the benefits and how the referral process works. The patient is then transferred to a PMHM Staff Psychologist who conducts an initial assessment to determine:
- Why the patient called PMHM
- Nature and scope of problem
- History of the problem
- Patient’s mental status and psychiatric history (if applicable)
- Drug/alcohol use and history (if applicable)
- Patient’s medical condition
- Any special patient needs
During this call, the PMHM Psychologist refers the patient to a Network Provider in his or her area for a specific number of treatment visits. After the call, the PRC enters the patient’s information into PMHM’s Referral System and Treatment Authorization letters are generated for both the patient and the Provider. The Treatment Authorization specifies the Network Provider, the treatment being authorized and a specified number of sessions. For the patient to receive more care, the Provider must complete a Treatment Extension Authorization Request.
Authorization for outpatient treatment is made in keeping with benefit plan requirements and PMHM’s Clinical Protocols.
For inpatient treatment, PMHM will precertify and monitor the care, as described below.
