Green Spring criteria for medical necessity of outpatient treatment and its use in a mental health utilization review program.
The authors have developed a two-tiered method for utilization review of outpatient mental health services. The methodology looks at initial and continued treatment evaluation and uses diagnosis, symptoms, plan of treatment, and the Global Assessment Scale (GAS) among other indicators to determine appropriateness of treatment. Preliminary program experience has been positive and is included.
Nyman
G
G
Green Spring Mental Health Services, Silver Spring, MD.
Harbin
H
H
Book
J
J
Wiegand
D
D
Lizanich-Aro
S
S
Krajewski
T
T
Yuhas
M
M
Shoffeitt
P
P
D000553:Ambulatory Care / Q000706:statistics & numerical data*; D054598:Blue Cross Blue Shield Insurance Plans; D006301:Health Services Needs and Demand; D006801:Humans; D007345:Insurance Claim Review / Q000592:standards*; D007358:Insurance, Psychiatric / Q000706:statistics & numerical data; D008396:Maryland; D008605:Mental Health Services / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D014600:Utilization Review / Q000379:methods*