Behavioral Health

At MetroPlusHealth, we believe in treating physical and behavioral health as equal parts of our responsibility to our members. As health care providers, we know you share this philosophy. Behavioral health benefits are an integral component of our health plans, enabling us to offer our members the full range of coordinated care.

Our participating behavioral health providers work directly with us to ensure MetroPlusHealth members get the right care.

In addition to the behavioral health supports providers receive from us, MetroPlusHealth also performs the following functions:

  • Credentialing and Contracting

  • Member Services and Crisis Call Center

  • Utilization Management (including member appeals)

  • Claims Adjustment / Payment

  • 24 Hour Clinical Coverage

  • Case Management

  • Care Coordination

MetroPlusHealth members have access to a remarkable array of behavioral health benefits and services.

Click on any of the tabs below for information on behavioral health services for specific member groups:

Behavioral Health (BH) Mental Health and Substance Use Disorder Services
Children & Family Services
Adult Services
HARP Services

In addition, children enrolled in our Article 29-I Voluntary Foster Care Agency program (VFCA) are also eligible for the services and supports available through Children & Family Services. Learn more about VFCA here.

HIV SNP HARP-eligible members are eligible for BH HCBS services. Learn more about our HIV SNP benefits and services here.

Many Behavioral Health resources are available to help providers make sound decisions regarding patients’ mental health and substance use issues. Below are some of the screenings and guidance providers can utilize.

PROGRAM DESCRIPTIONS
Utilization Management – Coming Soon
Care Management – Coming Soon

Several factors impact whether a service or procedure is covered under a member’s benefit plan. Medical and behavioral health policies and clinical utilization management (UM) and clinical practice guidelines are resources that help us determine if a procedure is medically necessary. These documents are available below to you as a reference when interpreting claim decisions for our members.

POLICIES AND CLINICAL GUIDELINES
Behavioral Health Policies – Coming Soon
Clinical Utilization Management Guidelines
Clinical Practice Guidelines

Our updated Provider Manual is available here.

MetroPlusHealth is committed to supporting you with the tools you need to serve your patients — our members.

CLICK HERE TO VIEW OUR BEHAVIORAL HEALTH FAQS

ADDITIONAL PROVIDER RESOURCES
Claims Information
CORE Provider Service Initiation Notification Form
Tools
Forms
Project TEACH
Mental Health Consult for Pediatricians

Our training materials and calendar can be found below.

Providers can register here to attest that they have viewed the training materials for behavioral health.

Providers can also visit our Good4You Health Library, where a robust collection of articles and other tools to support your patients’ physical, mental, and emotional wellbeing can be found.

For those times when getting to a doctor is not easy, MetroPlusHealth members and their dependents under age 18 can also use our Virtual Visit telehealth program, offering free 24/7 telehealth visits with board-certified or licensed providers, including emergency medicine trained medical doctors and psychiatrists, social workers, and addiction counselors.

Learn more about Virtual Visit to see if it can be of use to your MetroPlusHealth patients.

Our Member Services team is always here to help, too.

Member Services is available Monday through Saturday, 8:00AM to 8:00PM at 1-800-303-9626.
After hours, Sundays, and holidays, you will be connected to our 24/7 Customer Service Hotline.

After hours, our Behavioral Health Crisis partner, Vibrant Emotional Health, can be reached at 1-866-728-1885.
Useful Contact Information:

last updated: June 23, 2022

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