Issued:  April 29, 2019

Utilization Management Update: Unmanaged Units for Outpatient Behavioral Health Services

In years past, Service Authorization Requests (SARs) submitted in AlphaMCS for Outpatient Behavioral Health Services that extended into the new fiscal year on July 1, 2019 automatically forfeited the unmanaged visits.

Effective immediately, Outpatient Behavioral Health Providers no longer need to end date the SAR request on June 30, 2019. Partners will continue to pay up to 26 unmanaged units (for Medicaid-funded clients) and ten unmanaged units (for State-funded clients) regardless of the authorization. Partners Utilization Management recommends that Outpatient Behavioral Health Services providers track the units requested for members so they are aware when they are approaching the annual benefit limit. After the unmanaged units are utilized for the fiscal year, prior authorization will be required.

If you have any additional questions, please contact the Mental Health/Substance Use (MHSU) UM Workgroup at 704-842-6436.