- Doctorate Level Psychologists (Ph.D.)
- Licensed Clinical Social Workers (LSCSW)
- Licensed Chemical Dependency Counselors (LCDC)
- Psychiatrists (M.D.)
- Inpatient Treatment
- Partial Day Treatment
- Intensive Outpatient Treatment
Members may access care in a variety of ways. Some benefit plans allow members to have access to PMHM’s providers through an online or paper Provider Directory. Others may require the member to call PMHM to access care.
In plans which use PMHM as the treatment gatekeeper, when the member contacts PMHM, he or she receives an immediate telephonic assessment by a PMHM Staff Psychologist.
During this process, PMHM’s Psychologist obtains enough information to evaluate the member’s specific needs and refer the patient to an appropriate provider or treatment facility.
PMHM’s automated provider information system allows for searches by both zip code and specialty. The specialty information available on each provider includes language(s) spoken, diagnostic specialties, expertise with specific populations, and previous treatment outcome/patient satisfaction results.
In addition to speaking with the PMHM Staff Psychologist, members who call also speak with a Patient Relations Coordinator (PRC). The PRC works with the caller to establish insurance eligibility and explain benefits. The PRC is available if the caller has questions or wishes to change providers.
In its Quality Assurance Program, PMHM surveys Members and Providers about their treatment referral experience. Every patient who receives treatment with a PMHM Network Provider receives a Patient Satisfaction Survey. This survey reviews the patient’s satisfaction with PMHM’s referral process and the Network Provider’s accessibility and availability. In addition, the survey asks the patient’s opinion regarding his or her treatment outcome.
A key component of PMHM’s Quality Assurance Program is the exceptional partnerships we have with our Providers. PMHM’s Patient Relations staff works hard to maintain a high level of Provider satisfaction. To track Provider satisfaction, we request feedback on many aspects of our referral program.
PMHM uses the survey feedback in identifying provider-specific and system-wide problems, as well as in developing new solutions and program innovations.
PMHM’s assistance is just a phone call away. As a Member, you may call PMHM’s toll-free hotline seven-days a week, twenty-four hours a day. PMHM’s services are available 365-days a year.
For non-English speaking members, PMHM provides instantaneous phone translation services (Spanish + more than 140 different languages). PMHM’s Crisis Intervention Case Managers are available evenings, nights, weekends and holidays to meet Members’ needs. Any call of an emergency nature is handled immediately by one of our Crisis Intervention Managers or a PMHM Staff Psychologist, as clinically indicated.
PMHM’s Care Managers and Staff Psychologists are available 24-hours a day for consultation, referrals and crisis intervention.
PMHM’s Professional Guided Care Program SM seeks to ensure that each patient receives the correct treatment in the most appropriate treatment setting. After the expiration of PMHM’s initial authorization, the Provider may request more treatment sessions or days as required. Regardless of PMHM’s authorization with regard to benefit payment, the Provider must provide the amount and type of treatment each patient requires.
In the event that PMHM denies further benefit payments, the Covered Member may initiate an appeal (you may call PMHM to assist the patient in this process). PMHM’s Case Management System has a three-tiered approach, initially using clinical peer review and using independent reviewers at the highest level of appeal. PMHM’s timeliness standards for Clinical Appeals are one (1) business day for expedited appeals and ten (10) business days for standard appeals. In all appeals PMHM requires that the patient’s full medical record be submitted.
For more information about PMHM’s Appeals Process or to initiate an appeal, you may call 800-776-4357.