Nov. 5, 2015

Behavioral Health Utilization Management Affirmation Statement

The purpose of the Blue Cross and Blue Shield of Oklahoma (BCBSOK) Behavioral Health Utilization Management (UM) plan is to ensure that members receive medically necessary and appropriate care at the appropriate time and in the appropriate setting. BCBSOK will help our members access their behavioral health benefits and improve coordination of care between medical and behavioral health providers.

BCBSOK affirms that Utilization Management decisions are based on medical necessity; which includes appropriateness of care and services, and the existence of available benefits. BCBSOK further affirms that:

• The organization does not specifically reward health plan staff, providers, practitioners or other individuals for issuing denials of coverage, care or service.
• Incentive programs are not utilized to encourage decisions that result in under-utilization.
• BCBSOK does not allow decisions in exchange for financial rewards.

Visit the Clinical Resources/Behavioral Health section of our website at bcbsok.com/provider for more information including the Behavioral Health Medical Necessity Criteria. For additional information, call the Customer Service number on the back of the member’s ID card.