Behavioral Health Provider Update

Overview Upcoming changes for providers: What’s new & Who it effects Coding/Billing Information Credentialing/Enrollment

FOR BEHAVIORAL HEALTH PROVIDERS What’s New

Bulletin: MSA Michigan Department of Health and Human Services (MDHHS) has begun enrolling behavioral health providers to the Medicaid program. “Fee-for-service outpatient behavioral health visits will be increased from 10 to a maximum of 20 combined visits in a 12- month period, per beneficiary, by all providers of behavioral health services.”

What’s new? January 1 st, 2016, Behavioral Health provider will be able to bill Medicaid of Michigan for services. Link to Bulletin MSA 15-44: December 1 st, 2015, provider enrollment began. Provider Support: **Enrollment as a provider is done through CHAMPS with MDHHS. You must set up a user account before going forward with provider enrollment. Please use above link to access CHAMPS**

Who is eligible? Psychologists (Master’s Limited or Doctoral Level) Social Workers (Master’s Level) Professional Counselors (Master’s or Doctoral levels) **Limited licensed psychologists, social workers, professional counselors or student interns must be overseen by enrolled, fully- licensed provider of the same profession**

Who Is Eligible? Student Interns See Bulletin MSA Tribal Health Centers See Bulletin MSA 15-44

WHO IS ELIGIBLE Questions

PROCESS Coding & Billing

Behavioral Health CPT Codes Access full code list at: CPT CodeCode Description Max Fee Add-on code to be used in conjunction with codes for primary service: $9.11 psychiatric diagnostic evaluation (90791); psychotherapy (90832, 90834, 90837); and group psychotherapy (90853) Psychiatric diagnostic evalaution $ Psychotherapy, 30 minutes with patient and/or family member30 minutes $ Psychotherapy, 45 minutes with patient and/or family member45 minutes $ Psychotherapy, 60 minutes with patient and/or family member60 minutes $ Psychotherapy for crisis, first 60 minutes 60 minutes $ Add on for each additional 30 minutes of psychotherapy for crisis, usedeach additional $35.26 in conjunction with code minutes Family psychotherapy, with patient present $ Group psychotherapy $14.26

How to Use Codes Actual length of sessionCode AsCode DescriptionMax Fee 0-15 minutesNot reported minutes minutes (with patient and/or family member) $ minutes minutes (with patient and/or family member) $ minutes minutes (with patient and/or family member) $70.13 Group Psychotherapy90853 $14.26

How to use Codes cont.

Billing Electronically accepted Professional format ASC X12N CMS 1500 paper claims See manual for specifics on submitting Manual: ~Policy and Forms ~Medicaid Provider Manual

CODING & BILLING Questions

PROCESS Credentialing & Enrollment

Credentialing Credentialing & Enrollment ~Identification/verification of all required documents and information ~Facility and/or group ~Practitioner ~Creation/update of practitioner’s Council for Affordable Quality Healthcare [CAQH] file ~Identification of geographic area’s insurance payers ~Registration & enrollment with identified payers ~Continued attestation of CAQH and payer enrollments/credentialing

Enrollment Enrollment with Medicaid of Michigan ~Scroll down under Hot Topics and click on Champs icon ~Single Sign On (SSO) Sign Up for user access Access Information ed ~Start enrollment process MDHHS Provider Support:

CREDENTIALING & ENROLLMENT Questions

Review January 1 st, 2016 start providing behavioral health services December 1, 2015, enrollment began Credentialing/Enrollment Who is eligible: Psychologists (Master’s Limited or Doctoral Level) Social Workers (Master’s Level) Professional Counselors (Master’s or Doctoral levels)

Useful Information _504790_7.pdf 44_504790_7.pdf MDHHS Provider Support:

Resources  (2013, March 7 th ). National Council For Community Behavioral Healthcare. Retrieved from content/uploads/2013/06/NC-CPT-FAQ-for V3.pdf. content/uploads/2013/06/NC-CPT-FAQ-for V3.pdf  MSA Bulletin. (2015, October 30). Retrieved from 44_504790_7.pdf. 44_504790_7.pdf

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