Utilization Management

The Spokane County Regional Behavioral Health (SCRBH) provides Utilization Management (UM) services 24 hours, 7 days per week, 365 days per year for non-Medicaid covered behavioral health services for eligible individuals in the Spokane Regional Service Area (RSA). The SCRBH UM team may be contacted:

Local and Toll-Free Telephone Access 

The CSD SCRBH Behavioral Health UM Team is available 24/7:

• Local: (509) 477-4600
• Toll-Free: 1 (877) 226-0741
• Email:  SCRBHUM@spokanecounty.org

Secure Fax at 1 (509) 232-3130 for CSD SCRBH UM is monitored during business hours 8:00 AM to 5:00 PM Pacific Time, Monday through Friday, year-round except on recognized federal or state holidays.

Secure Messaging in the CSD SCRBH Raintree Data System for contracted behavioral health providers.

The CSD SCRBH Utilization Management (UM) program serves to implement a process that actively evaluates and manages utilization of behavioral health care resources delivered to all Individuals, and to actively pursue identified opportunities for improvement. The program serves to:

• Assure Individuals receive the appropriate quantity and quality of behavioral health services within available resources;
• Assure that the behavioral health services are delivered at the appropriate time; and
• Assure that the setting in which the behavioral health services are delivered is consistent with the treatment care needs of the Individual.

The SCRBH Utilization Management activities are conducted by Washington State Department of Health licensed behavioral health professionals, which operate under the guidance of a board-certified psychiatrist and Addictionologist.

The CSD SCRBH has board-certified psychiatrists, including board-certified psychiatrists in child or adolescent psychiatry or Addiction Medicine, available 24 hours, 7 days per week, 365 days per year for any authorization decisions that result in a denial for covered behavioral health services for non-Medicaid Individuals in the Spokane RSA.

The CSD SCRBH utilizes a standard protocol applying Level of Care Guidelines and medical necessity criteria for making authorization decisions for financially eligible Individuals for routine outpatient behavioral health services funded with state non-Medicaid or block grant funds within Available Resources.

Authorizations will only be provided for behavioral health treatment within the CSD SCRBH provider network of mental health and substance use disorder treatment facilities within the exception of acute psychiatric inpatient admissions and involuntary secure withdrawal management and stabilization services admissions.

The CSD SCRBH prohibits any financial incentives based on an individual UM clinician's number of adverse determinations/adverse actions or denials of payment. Additionally, the CSD SCRBH UM decision makers do not receive any financial incentives for decisions that result in under-utilization.