Substance use disorder treatment authorizations
For information on authorization and billing for specific types of substance use disorder treatment, see these pages under Procedures & services > Behavioral health > Substance use treatment:
See the Approved Drug List for information on how medications used to treat substance use disorders are covered.
Substance use disorder authorizations
Members/participants/beneficiaries must meet InterQual® Behavioral Health medical necessity criteria. We also require ongoing clinical reviews to determine if the member continues to meet medical necessity criteria for treatment.
Medical Necessity - 91447
Computer-generated or typewritten notes are preferred. Hand-written documentation may delay the review process and require extra phone calls to clarify information and clinical content.
Include:
- CIWA or COWS score if available
- All vitals including blood pressure, pulse, temperature and respirations
- Any specific withdrawal symptoms that the patient is currently exhibiting
- The specific dates of any transfers from one level of service to another
In-network providers
In-network providers can request authorization for mental health and substance use disorder services, evaluations and discharges using GuidingCare Auth Portal.
Request an authorization
Out of network providers
If you’re a provider located within the state of Michigan and would like to join our provider network, visit our credentialing application page.
Out of network providers request mental health and substance use disorder services using our authorization request forms.