Service Numbers

SWMBH Main Line: 800-676-0423
SWMBH Customer Service: 800-890-3712
SWMBH Compliance Hotline: 800-783-0914
SWMBH SUD Access Line: 800-781-0353
SWMBH Portal

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Crisis Phone Number: 1-800-675-7148

For the latest update to our Medical Necessity Criteria, click here.

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MI Health Link Policies

MI Health Link (1 documents)

SWMBH UM Program for MI Health Link Medicare
1.05 MB

MHL General Management (1 documents)

MHL 1.0 Stakeholder Participation on ICO Advisory Committee
647.53 KB

MHL Provider Network Management (11 documents)

MHL 2.11 Ongoing Monitoring of Network Practitioners and Organizations
1.00 MB
MHL 2.10 Provider Grievance and Appeal - Non-Clinical
747.70 KB
MHL 2.9 Provider Network Monitoring
151.45 KB
MHL 2.8 Network Capacity Analysis
436.40 KB
MHL 2.7 Out of Network Providers
502.65 KB
MHL 2.6 Participating Provider Precautionary Suspension
487.30 KB
MHL 2.5 Provider Communication
466.65 KB
MHL 2.4 Credentialing Committee, Confidentiality of Credentialing Records, and Provider Nondiscrimination
755.52 KB
MHL 2.3 Clean Credentialing and Re-Credentialing Files
608.25 KB
MHL 2.2 Credentialing and Re-Credentialing - Organizational Providers
371.82 KB
MHL 2.1 Credentialing and Re-Credentialing - Behavioral Health Practitioners
1.43 MB

MHL Quality Management (6 documents)

MHL 3.6 Cultural and Linguistic Competencies
29.78 KB
MHL 3.5 Access Timeliness Standards
40.99 KB
MHL 3.4 Member Input and Satisfaction of Provider Services
43.54 KB
MHL 3.3 Behavior Treatment Review Committee (BTRC)
39.38 KB
MHL 3.2 Quality Assurance and Performance Improvement
34.31 KB
MHL 3.1 QAPI Program for Members Enrolled in MHL
23.80 MB

MHL Utilization Management (11 documents)

MHL P4.4.1 Service Authorization Request and Determination Procedure
522.34 KB
MHL P4.3.1 Adverse Action Procedure
840.00 KB
MHL P4.1.1 Processing Retrospective Review Request Procedure
226.70 KB
MHL 4.11 Stakeholder Participation on ICO Advisory Committee
307.37 KB
MHL 4.7 Qualifications of Staff Making Medical Necessity and Clinical Decisions
286.03 KB
MHL 4.6 Utilization Management
493.00 KB
MHL 4.5 Consistency in Applying Criteria
351.32 KB
MHL 4.4 Service Authorizations and Notice of Determinations
1.72 MB
MHL 4.3 Clinical Protocols and Practice Guidelines
198.79 KB
MHL 4.2 Access Management, Triage, and Referral
1.25 MB
MHL 4.1 Retrospective Review
178.66 KB

MHL Member Service (11 documents)

MHL 6.3 Notification of Practitioner Network Changes
361.82 KB
MHL P6.8.1 Medicare Member Adverse Benefit Determination Appeal Procedure
858.43 KB
MHL P6.7.1 Medicare Member Grievance Procedure
838.34 KB
MHL P6.4.1 Medicaid Medical Necessity Payment Denial Procedure
3.59 MB
MHL 6.8 Medicare Member Adverse Benefit Determination Appeal
2.30 MB
MHL 6.7 Medicare Member Complaint - Grievance and Appeal
1.53 MB
MHL 6.6 Member Education and Marketing Orientation
321.58 KB
MHL 6.5 Member Services Responsibilities
183.48 KB
MHL 6.4 Limited English Proficiency
339.74 KB
MHL 6.2 Enrollee Rights and Responsibilities
359.90 KB
MHL 6.1 Advance Directives
695.83 KB

MHL Information Systems (2 documents)

MHL 7.2 IT Requisitions
106.44 KB
MHL 7.1 ISM Data, Retention, and Maintenance
177.15 KB

MHL Claims (13 documents)

MHL 9.1 Claims Adjudication
120.93 KB
MHL 9.2 Claims Overpayments
680.73 KB
MHL 9.3 Electronic Claims Submission
49.89 KB
MHL 9.4 Provider Communication
61.25 KB
MHL 9.5 Provider Appeals and Grievances
137.68 KB
MHL 9.6 State and Federal Regulations
161.03 KB
MHL 9.7 Paper Claim Submission, Receipt, and Processing Controls
115.04 KB
MHL 9.8 Enrollee Cost Sharing Prohibition
53.74 KB
MHL P9.8.1 Enrollee Claims Status Script Procedure
65.18 KB
MHL 9.9 Member Plan Coverage Eligibility Determination
84.94 KB
MHL 9.10 Timely Payment of Claims/Quality Assurance
101.15 KB
MHL 9.11 Claim Denials Due to Member Coverage
96.00 KB
MHL 9.12 Non-Participating Provider Reimbursement
72.15 KB

MHL Compliance (4 documents)

MHL 10.1 Development of Compliance Plan Policies and Procedures
589.97 KB
MHL 10.2 Conflict of Interest
893.16 KB
MHL 10.3 Breach Notification
1.04 MB
MHL 10.4 60-Day Requirement for Reporting and Returning
97.13 KB

MHL Clinical Practices (16 documents)

MHL P12.13.1 Psychological/Neuropsychological Testing Authorization Procedure
398.96 KB
MHL P12.12.1 Electroconvulsive Therapy Authorizations Procedure
710.63 KB
MHL P12.7.1 Complex Case Management Procedure
321.36 KB
MHL P12.3.1 Clinical Documentation Procedure
802.17 KB
MHL 12.13 Psychological Testing and Neuropsychological Testing
446.69 KB
MHL 12. 12 Electroconvulsive Therapy Authorization
632.68 KB
MHL 12.11 Disease Management Policy and Procedure
573.01 KB
MHL 12.10 Emergent, Urgent, and Post-Stabilization Behavioral Health Services
297.36 KB
MHL 12.9 Integrated Healthcare
677.29 KB
MHL 12.8 Transition and Discharge
230.10 KB
MHL 12.7 Complex Case Management - Monitoring
184.83 KB
MHL 12.4 Jail Diversion
291.35 KB
MHL 12.5 Supports Intensity Scale
583.06 KB
MHL 12.3 Clinical Documentation
458.80 KB
MHL 12.2 Trauma Informed Practices
248.14 KB
MHL 12.1 Recovery/Relapse/Effective Freedom
287.75 KB

SWMBH Policies

General Management (6 documents)

SWMBH 1.1 Policy Development and Approval Process
260.67 KB
SWMBH 1.2 Policy and Procedure Expectation
148.30 KB
SWMBH 1.3 Procurement
1.88 MB
SWMBH 1.4 New Hire Orientation and Training Schedule
545.00 KB
SWMBH 1.5 PTO Donations
208.84 KB
SWMBH 1.6 Driving Personal Vehicle Work
584.70 KB

Provider Network Management (18 documents)

SWMBH 2.1 Delegation of Credentialing
490.71 KB
SWMBH 2.2 Crdtlg Rcrdlg of Bhvl Hlth Prctnrs
1.52 MB
SWMBH 2.3 Crdtlg Org Prvds
817.04 KB
SWMBH 2.4 Clean Credentialing and Re-Credentialing Files
598.23 KB
SWMBH 2.5 Credentials Comm Conf of Cred Recs and Provider Nondiscrimination
704.91 KB
SWMBH 2.6 Org Providers Credentialing of Practitioners
1.12 MB
SWMBH 2.7 Provider Communication
485.59 KB
SWMBH 2.8 Network Directory and Network Reporting Obligations
683.42 KB
SWMBH 2.9 Participating Provider Precautionary Suspension
530.52 KB
SWMBH 2.10 Sub Contracting
730.27 KB
SWMBH 2.11 Out of network providers
483.40 KB
SWMBH 2.12 Network Adequacy Analysis
232.12 KB
SWMBH 2.13 Provider Network Monitoring
811.76 KB
SWMBH 2.14 Grievance and Appreal non-clinical
747.10 KB
SWMBH 2.15 Provider Training
1.07 MB
SWMBH 2.16 Criminal History Screening
1.60 MB
SWMBH 2.17 Provider Office Site Quality
220.35 KB
SWMBH 2.18 Ongoing Network Provider Monitoring
638.02 KB

Quality Management (7 documents)

SWMBH 3.1 QAPIP 2017
1.02 MB
SWMBH 3.2 Quality Assurance and Performance Improvement
489.56 KB
SWMBH 3.3 Behavior Treatment Review Committee (BTRC)
356.40 KB
SWMBH 3.4 Stakeholder Input and Satisfaction of Provider Services
339.09 KB
SWMBH 3.5 Incident Event and Death Reporting and Monitoring
689.83 KB
SWMBH 3.6 Access Standards and Monitoring
415.41 KB
SWMBH 3.7 Cultural and Linguistic Competencies
302.79 KB

Utilization Management (16 documents)

Consent to Share Behavioral Health Information for Care Coordination Purposes
36.74 KB
MHL Auth Request Sheet
94.78 KB
OMT
1.14 MB
Psychological-Neuropsychological Evaluation Request Form
151.64 KB
SWMBH 4.1 Access Management Policy
589.34 KB
SWMBH 4.2 Utilization Management
797.23 KB
SWMBH P4.2.1 Access Mgmt Triage Referral Protocol
896.32 KB
SWMBH 4.3 Service Authorization Outlier Management (URAC)
5.40 MB
SWMBH 4.4 Medical Necessity Criteria Clinical Practice Guidelines
2.15 MB
SWMBH 4.5 Person Family Centered Planning Policy
1.21 MB
SWMBH 4.6 Self Determination Policy
3.26 MB
SWMBH 4.7 Competitive Employment For Disabled Persons
310.71 KB
SWMBH 4.8 Retrospective Review
157.48 KB
SWMBH MHL Outpatient Mental Health Auth Processes
43.14 KB
SWMBH MI Health Link Phone Numbers
77.79 KB
SWMBH Notice of Confidentiality and Privacy Practices Jan 2014
141.12 KB

Public Policy (1 documents)

SWMBH 5.1 Community Living
561.95 KB

Customer Service (10 documents)

SWMBH 6.1 Customer Services Roles and Delegation
370.10 KB
SWMBH 6.2 Community Benefit
199.01 KB
SWMBH 6.3 Advance Directives
646.65 KB
SWMBH 6.4 Customer Grievance Systems
1.26 MB
SWMBH 6.5 Limited English Proficiency
364.57 KB
SWMBH 6.6 Customer Advisory Committee
357.56 KB
SWMBH 6.7 Customer Education and Marketing Orientation
302.04 KB
SWMBH 6.8 Enrollee Rights and Responsibilities
198.70 KB
SWMBH 6.9 CS Policy Notification of Provider Network Changes
299.55 KB
SWMBH 6.10 Stipends To Customers and Family Members
1.09 MB

Information Systems Management (7 documents)

SWMBH 7.1 Data Storage Retention Maintenance
180.22 KB
SWMBH 7.2 Workstation Use
472.02 KB
SWMBH 7.3 Internet Acceptable Use
365.72 KB
SWMBH 7.4 ISM Information Security
637.38 KB
SWMBH 7.5 IT Requisition
148.14 KB
SWMBH 7.6 Privacy Folder Access
325.86 KB
SWMBH 7.7 Portal Access
557.70 KB

Financial Management (1 documents)

SWMBH 8.4 Approval Limits Policy
132.61 KB

Claims (12 documents)

SWMBH 9.1 Claims Adjudication
548.40 KB
SWMBH 9.2 Claims Overpayment and Refunds
714.94 KB
SWMBH 9.3 Electronic Claims Submission
448.98 KB
SWMBH 9.4 Provider Communication
494.43 KB
SWMBH 9.5 Provider Claims Grievances and Appeals
581.16 KB
SWMBH 9.6 State and Federal Regulations
529.47 KB
SWMBH 9.7 Paper Claims Control
526.44 KB
SWMBH 9.8 Enrollee Cost Sharing
452.62 KB
SWMBH P9.8.1 Enrollee Claims Status Script
118.20 KB
SWMBH 9.9 Member Plan Coverage Eligibility Determination
502.76 KB
SWMBH 9.11 Claim Denials Due to Member Coverage
519.66 KB
SWMBH 9.12 Financial Liability Determination ATP
910.71 KB

Compliance (23 documents)

SWMBH 10.1 Corporate Compliance Plan FINAL
5.30 MB
SWMBH 10.2 Comp Policy Development of Comp Plan Policies and Procedures
588.32 KB
SWMBH 10.3 Code of Conduct Distribution and Training
1.66 MB
SWMBH 10.4 Compliance Oversight Committee
590.36 KB
SWMBH 10.5 Compliance Education and Training
611.58 KB
SWMBH 10.6 Compliance Reporting Responsibilities
578.52 KB
SWMBH 10.7 Compliance Auditing and Monitoring
594.94 KB
SWMBH 10.8 Compliance Reviews and Investigations for Reporting
822.40 KB
SWMBH 10.9 Compliance Enforcement and Discipline
553.32 KB
SWMBH 10.10 Conflict of Interest
1.99 MB
SWMBH 10.10a COI Waiver SWMBH Board
514.94 KB
SWMBH 10.11 Fraud and Abuse
676.98 KB
SWMBH 10.12 Freedom of Information Request Policy
2.90 MB
SWMBH 10.13 Federal Program Eligibility Screening and Exclusion Disclosure
560.19 KB
SWMBH P10.13.1 Federal Program Eligibility Screening and Exclusion Disclosure Procedure
8.39 MB
SWMBH 10.14 Appeal Process For Compliance Decisions
582.72 KB
SWMBH 10.15 Clinical Documentation Review Policy
727.59 KB
SWMBH 10.16 Breach Team Program Oversight
1.67 MB
SWMBH 10.17 Social Security Privacy Policy
606.85 KB
SWMBH 10.18 Breach Notification
1.01 MB
SWMBH 10.20 Compliance Document Retention
566.50 KB
SWMBH 10.21 Use of MDHHS Standard Consent Form
559.81 KB
SWMBH 10.22 Requirement for Reporting and Returning Overpayments
519.08 KB

Substance Abuse Treatment and Prevention (22 documents)

SWMBH 11.1 Treatment Planning SUD
419.20 KB
SWMBH 11.2 SA Wait list
220.01 KB
SWMBH 11.3 Womens Treatment
453.75 KB
SWMBH 11.4 Services for Women and their Children
163.04 KB
SWMBH 11.5 Communicable Disease Testing & Education
411.52 KB
SWMBH 11.6 Cnfdlty Dsclsre of SA Info
786.28 KB
SWMBH 11.7 MI Child Admin CA Services
522.45 KB
SWMBH 11.8 Professional Development Plan
194.61 KB
SWMBH 11.9 Fetal Alcohol Spectrum Disorders
351.06 KB
SWMBH 11.10 Substance Abuse Prevention Services (1)
1.67 MB
SWMBH 11.11 Recipient Rights of SA Consumers
371.75 KB
SWMBH 11.13 Substance Abuse Service Auth Guidelines
679.02 KB
SWMBH 11.14 Admission Criteria and Intake Procedures SARF
649.40 KB
SWMBH 11.15 Referrals for SARF
173.37 KB
SWMBH 11.16 Staff Development Program SARF
160.45 KB
SWMBH 11.17 Substance Abuse Services for Minors
151.68 KB
SWMBH 11.18 OMT
1.35 MB
SWMBH 11.19 Substance Abuse Operating Manual SARF
108.57 KB
SWMBH 11.20 Disclosure of Conf Info SARF
1.29 MB
SWMBH 11.21 Substance Abuse Treatment Documentation SARF
450.19 KB
SWMBH 11.22 Transportation
575.06 KB
SWMBH P11.22.1 Transportation
780.50 KB

Clinical Practices (21 documents)

SWMBH 12.1 Assessment and Services for Co-Occurring Disorders
489.90 KB
SWMBH 12.2 Integrated Collaborative Care
636.24 KB
SWMBH 12.3 Emergency Mental Health Services
533.58 KB
SWMBH 12.4 Electroconvulsive Therapy
329.89 KB
SWMBH 12.5 Discharge Planning and Follow-Up
208.91 KB
SWMBH P12.5.1 Discharge and Follow-Up Procedure
272.21 KB
SWMBH 12.6 County of Financial Responsibility (COFR)
454.72 KB
SWMBH 12.7 Pre-Admission Screening
373.49 KB
SWMBH 12.8 Autism Services policy
757.03 KB
SWMBH P12.8.1 Autism Benefit Enrollment and Authorization Procedure
10.40 MB
SWMBH 12.9 Recovery Relapse Effective Freedom
254.99 KB
SWMBH 12.10 Trauma Informed System of Care
274.71 KB
SWMBH 12.11 Clinical Documentation
866.10 KB
SWMBH 12.12 Jail Diversion
238.21 KB
SWMBH 12.12A Jail Diversion Practice Guidelines
844.51 KB
SWMBH 12.13 Supports Intensity Scale
206.93 KB
Self Determination Practice & Fiscal Intermediary Guideline
2.43 MB
Inclusion Practice Guideline
279.83 KB
Housing Practice Guideline
238.78 KB
Consumerism Practice Guideline
376.32 KB
Family-Driven and Youth-Guided Policy/Practice Guideline
922.26 KB

Provider Forms and Documents

Downloadable Forms (9 documents)

Consent to Share Behavioral Health Information for Care Coordination Purposes
36.74 KB
Consent to Share Health Information (Spanish)
43.88 KB
SWMBH Adverse Benefit Determination for UM Denials
114.38 KB
SWMBH Grievance Determination Template
260.46 KB
SWMBH Grievance Acknowledgement Template
276.13 KB
SWMBH Appeal Determination Template
254.43 KB
SWMBH Appeal Acknowledgement Template
115.86 KB
Appeal form
29.58 KB
MHL SWMBH IntegratedDenialNotice MI 2015
61.67 KB

Provider Forms General Information (4 documents)

Phone System v.2.1.16
514.86 KB
SWMBH Duals Web Ex Feb_15
520.55 KB
SWMBH Powerpoint Provider Network
457.60 KB
SWMBH Process Flow Charts
352.31 KB

Provider Manual

Introduction (4 documents)

Briefing for Stakeholders 2014
156.59 KB
Letter of Welcome 2014
61.20 KB
SWMBH Affiliate Locations
33.44 KB
SWMBH Org Chart functional 3.31.15
186.55 KB

Provider Network (8 documents)

Applicant Credentialing Rights
31.39 KB
Credentialing Process SWMBH
42.36 KB
Malpractice Claims Explanation Form
51.59 KB
Provider Disputes Appeals Process SWMBH
34.46 KB
Reporting Material Changes
29.32 KB
SWMBH Independent Practitioner Credentialing Final 1.25.16
169.20 KB
SWMBH Organization Credentialing App 6-30-14
170.06 KB
W-9 Form
84.44 KB

Practice Guidelines (19 documents)

Consumerism PracticeGuidelines
361.39 KB
Employment Works Policy
321.73 KB
Family Driven and Youth Guided Policy and Practice Guidelines
737.97 KB
Housing Practice Guideline
226.57 KB
Inclusion Practice Guideline
283.64 KB
Jail Diversion Practice Guidelines
848.23 KB
Person-Centered Planning Practice Guideline
1.13 MB
Personal Care in Non-Specialized Residential Setting Technical Requirement
438.80 KB
Recovery Policy and Practice Advisory
599.33 KB
SED Technical Requirements
2.73 MB
Self Determination Policy and Practice Guideline
2.50 MB
Special Education to Community Transition Planning Practice Recommendation Guideline
2.10 MB
Self Determination Practice Fiscal Intermediary Guideline
2.43 MB
Bipolar Disorder
1.74 MB
Bipolar Disorder Quick Reference Guide
155.30 KB
Major Depressive Disorder
1.65 MB
Major Depressive Disorder - Quick Reference Guide
155.84 KB
Substance Use Disorders
2.86 MB
Substance Use Disorders - Quick Reference Guide
216.71 KB

Corporate Compliance (1 documents)

SWMBH 10.1 Corporate Compliance Plan FINAL 12/11/2015
145.43 KB

Performance Improvement (3 documents)

BH-TEDS Coding Instructions
482.36 KB
MI Indicator System FY14
24.97 KB
SWMBH PI Plan
912.51 KB

Consumer Rights (6 documents)

2017 SWMBH Handbook-Spanish
1.34 MB
Consumer Rights 2014
64.89 KB
MHL SWMBH IntegratedDenialNotice MI 2015 022715
61.67 KB
SA Consumer Rights 2014
27.19 KB
SWMBH Action Notice Medicaid Spanish Aug-2014
182.68 KB
SWMBH Action Notice Medicaid Template December 2016
54.01 KB

Utilization Management (16 documents)

Consent to Share Behavioral Health Information for Care Coordination Purposes
36.74 KB
MHL Auth Request Sheet
94.78 KB
OMT
1.14 MB
Psychological-Neuropsychological Evaluation Request Form
151.64 KB
SWMBH 4.1 Access Management Policy
589.34 KB
SWMBH 4.2 Utilization Management
797.23 KB
SWMBH P4.2.1 Access Mgmt Triage Referral Protocol
896.32 KB
SWMBH 4.3 Service Authorization Outlier Management (URAC)
5.40 MB
SWMBH 4.4 Medical Necessity Criteria Clinical Practice Guidelines
2.15 MB
SWMBH 4.5 Person Family Centered Planning Policy
1.21 MB
SWMBH 4.6 Self Determination Policy
3.26 MB
SWMBH 4.7 Competitive Employment For Disabled Persons
310.71 KB
SWMBH 4.8 Retrospective Review
157.48 KB
SWMBH MHL Outpatient Mental Health Auth Processes
43.14 KB
SWMBH MI Health Link Phone Numbers
77.79 KB
SWMBH Notice of Confidentiality and Privacy Practices Jan 2014
141.12 KB

Provider Training Materials

Provider Training Materials (9 documents)

SWMBH Care Management User Guide
1.66 MB
SWMBH Advance Directives Training
335.11 KB
SWMBH Code of Conduct 2016
200.02 KB
SWMBH Compliance 2016 training
910.35 KB
SWMBH Grievance Appeal training
422.09 KB
SWMBH HIPAA Privacy and Security 2016 training
633.20 KB
SWMBH LEP Training
399.02 KB
SWMBH MCIS 837 Companion Guide Rev 1.5.16
155.89 KB
SWMBH MCIS Adjudication Logic
111.99 KB

SUD Providers

SUD Treatment Director's Meeting Information (13 documents)

August 2016 SUD Directors Minutes
408.81 KB
August 2016 SUD Directors Packet
916.75 KB
December 2015 packet
353.79 KB
February 2016 SUD Directors Meeting packet
3.11 MB
February 2016 SUD Directors Meeting packet
3.11 MB
June 2016 Agenda
335.84 KB
June 2016 SUD Directors Minutes
1.87 MB
October 2015 packet
4.09 MB
SUD Directors Mtg Packet April 2015
620.40 KB
SUD Program Director Minutes 12-2015
263.40 KB
SUD Program Director minutes 2/16/16
331.27 KB
SUD Program Director minutes april 2016
409.82 KB
SUD Program Director minutes october 20/2015
246.41 KB

Employee Resources (6 documents)

BH TEDS Errors
306.43 KB
BH TEDS Smartcare
928.29 KB
BH-TEDS QA 09/08/2016
701.09 KB
FY17 BH-TEDS Coding Instructions
628.32 KB
SWMBH BH TEDS for SUD Overview
312.48 KB
Tx Planning for SUD v3.0
674.84 KB

Community Resources (1 documents)

SpanishAAMeetingFlyer
40.97 KB

SUD Treatment Providers General Information (3 documents)

MAT Guidelines for Opiod Use Disorders
1.11 MB
SWMBH STRATEGIC PLAN NARRATIVE FINAL
778.52 KB
SWMBH Three year strategic plan attachments FINAL
1.83 MB
For the SWMBH Main Line, call
For the SWMBH Compliance Hotline, call
For SWMBH Customer Service, call
For the SWMBH SUD Access Line, call