Behavioral Health Outpatient Configuration Changes

UPDATE: 11/01/2024
LOB: Medicaid
Audience: Behavioral Health Providers

The Michigan Department of Health and Human Services has a Behavioral Health Authorization and Payment Responsibility Grid detailing which parties are responsible for authorizing and reimbursing care for Medicaid members' behavioral health services. Detailed guidance from the state can be found on the Medicaid Behavioral Health and Substance Use Disorder Authorization and Payment Responsibility Grid (PDF) (michigan.gov) as well as within the MDHHS Provider Manual.

Recent quality reviews revealed instances of providers billing Meridian outside these delegation requirements. To align our processes with MDHHS requirements, Meridian is actively meeting with State and PIHP partners to develop additional guidance and resources as we heard significant concerns raised by our Provider Community following our initial communications regarding this configuration change (10/14/2024).

In response to concerns raised, previous configuration will be restored effective immediately, as noted in the 10/18 update.

All claims that were inaccurately denied as a result of this activity will be paid by November 15.

We are grateful for the quick response and feedback. Meridian remains confident in this call to action and our ability to work together to find answers, so that we can provide the best care possible.