Service Authorization

Maryland Department of Health (MDH)/Behavioral Health Administration (BHA) pay for behavioral health services. These services must be authorized. This means that your provider needs to get approval from Optum Maryland before giving you certain services. Maryland’s Public Behavioral Health System has defined these services. For each of the following, medical necessity must be found for first stay requests. It is also needed for ongoing stay requests.

• Case Management Services
• Individual mental health practitioner services
• Inpatient Psychiatric Care
• Mobile Treatment Services
• Outpatient mental health clinic
• Psychiatric day treatment (partial hospitalization)
• Psychiatric Rehabilitation
• Residential Crisis Services
• Residential Rehabilitation
• Residential Treatment
• Respite
• Supported Employment and vocational services
• Supported Living Services

Here is how it works:

1. Optum Maryland or your local Core Service Agency (CSA) can help you find a provider.
2. The provider you select will request authorization for services for you.
3. Optum Maryland staff confirms that the request is based on your goals and needs. Our staff will also confirm that you were involved in the decision. We also ensure that the services requested meets medical necessity.
4. In most cases, Optum Maryland authorizes the services to be provided.
5. If not, Optum Maryland will work with you and your provider to find a service that better meets your goals and needs. 
6. You and/or your provider can ask questions or complain. You and/or your provider can also file an appeal if your needs are not met. The goal is not to deny service, but to work together to find the best fit with your care.