Medical Necessity Criteria
Learn more about the standards LifeSynch uses as a guide for utilization management decisions.
The Mihalik Group’s Medical Necessity Manual for Behavioral Health
LifeSynch has adopted The Mihalik Group’s Medical Necessity Manual for Behavioral Health as the written clinical review criteria to apply when making all utilization management decisions for behavioral health care Services unless state law mandates use of other criteria. In the absence of any state or account specific contractual criteria, The Mihalik Group’s Medical Necessity Manual for Behavioral Health is used.
The clinical criteria were developed by The Mihalik Group with guidance from a national panel of actively practicing physicians and other practitioners with current knowledge relevant to the criteria under review. The criteria are based on sound clinical principles and processes and are evaluated and updated by The Mihalik Group, as necessary, at least annually.
Additionally, LifeSynch’s utilization management subcommittee reviews the approved criteria at least annually. Criteria used for an adverse determination are disclosed to the physician, practitioner, provider, patient and/or patient’s authorized representative upon request.
Request Information: To request a paper copy of The Mihalik Group Medical Necessity Manual for Behavioral Health, please call 1-866-279-7214.
