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.
IMPORTANT NOTICE FOR PROVIDERS: Understanding How Adverse Childhood Experiences Affect Patients’ Health Across the Lifespan
Adverse Childhood Experiences (ACEs) are stressful or traumatic events, such as neglect and/or violence during childhood. ACEs are strongly related to brain development and a wide range of health problems throughout a person’s lifetime and may include, but are not limited to, physical or sexual abuse, domestic violence, living in poverty, death of a caregiver, exposure to discrimination, or living in a household with someone with mental illness, substance use disorder, or who has experienced incarceration. Read what ACEs research shows 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.
| SUICIDE PREVENTION RESOURCES |
|---|
| American Foundation for Suicide Prevention |
| National Suicide Prevention Lifeline |
| Mental Health Crisis Support |
| Mental Health America |
| Crisis Text Line |
| MULTICULTURAL RESOURCES |
|---|
| Behavioral Health Equity |
| Diversity and Health Equity |
| Identity and Cultural Dimensions |
| LGBTQIA+ |
| My Diverse Patients |
| 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:
- For MetroPlus Health Plan members: Medicare members call 1-866-986-0356. All other plans, call 1-800-303-9626, press prompt 1
- For provider referrals, authorization or clinical matters: 1-800-303-9626, press prompt 2
- For provider relations: 1-800-303-9626, press prompt 2
- For claims: 1-800-303-9626, press prompt 2
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Sunday | 9 a.m. –5 p.m. (ET)
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Sunday | 9 a.m. –5 p.m. (ET)
