NY Manual
SHP Manual

New York Provider Manual
9.2 Benefits and Access to Care | 9.4 Utilization and Medical Management Guidelines

9.3 Program Overview

The Behavioral Health Care Management Program is designed to maximize quality of care while providing services in a cost-effective manner. The program focuses on assisting providers in planning for, organizing, and managing the behavioral health services provided to Healthfirst members. Behavioral Health Care Management staff collaborate with network providers, community-based organizations and service agencies, contracted vendor organizations, and other Healthfirst staff to ensure that high-quality care is provided at the most appropriate level by the most qualified mix of providers.

The Healthfirst Behavioral Health Unit is responsible for the following areas:

• Notification process

• Authorization review

• Concurrent review

• Continuity of care

• Care coordination

Healthfirst offers a transitional care management program to members returning to the community from inpatient mental health treatment settings. This program provides enhanced care coordination and community-based support at no cost to our members.

For additional information about program components, please refer to Subsections 12.3–12.6. The Care Management Program is described in Section 13.