Medical Necessity Criteria

UMBH has adopted the Mihalik Group’s Medical Necessity Manual for Behavioral Health. The purpose of these medical necessity criteria is to guide all of UMBH’s utilization review activities. These criteria are scientifically based and were developed by a nationally recognized advisory panel. These criteria are licensed and protected by copyright laws.

If you would like to request a copy of the Mihalik Group’s Medical Necessity Manual for Behavioral Health you must request the specific level of care criteria that you would like to review. The criteria that you request should be relevant to your scope of practice and the level of care that you provide to UMBH enrollees. You may request a copy by mail, phone or by fax.

Click here to download the request form for Mihalik Group’s Medical Necessity Manual for Behavioral Health with Specific Level of Care Criteria.

 To request the copy by mail, please mail your request to the following address:
UMBH Attn: Clinical Operations
1320 South Dixie Highway Suite 400,
Coral Gables, Florida 33146.

To request a copy by phone, please call 1-800-294-8642 option 2 and option 2 again.

To request a copy by fax, please fax the completed request form to 305-243-7311.