IT System Implications for Temporary Changes to DHS/DMH UM Process Effective 4/22/11

  • The use of DMH UM criteria which was implemented on January 3, 2011, is being put on hold as of COB 4/21. No UM criteria will be applied 4/22 and after until DMH reinstates the criteria and authorization processes.
  • All UM service classes implemented on January 3, 2011 will be lifted. This includes therapy/counseling (TIN), Psychosocial Rehab (PSR), and Community Support Group (CSG).
  • Both Assertive Community Treatment and Community Support Team services will continue to require authorization
  • UM services submitted by providers will pass through the IT system 4/22 and after without any authorization on file. These services will be processed using parameters established for claims processing prior to January 3rd, 2011.
  • Claims related to UM services provided between January 3rd and April 21st COB will be processed using UM criteria.
  • UM service limits will be tracked up to 4/21 COB. When UM criteria and service threshold limits are reinstated, the count of units that are applied toward the threshold should be resumed from 4/21.
  • UM service units that are provided/used during the hold period will not be counted toward consumers' authorization thresholds.
  • Any service authorization requests for the UM services that are in process as of 4/21 or received after 4/21 will be voided and closed.
  • Processing of service authorization requests will continue per established parameters once the UM criteria are reinstated.