Attention NY Empire Plan providers. Effective October 1, 2014, Value Options has announced prior authorization will no longer be required for the Empire Plan enrollees for routine outpatient mental health and substance abuse services. The exception would be for psychological testing, outpatient electroconvulsive therapy and transcranial magnetic stimulation. This is GREAT news!
Beginning 4/1/2014, all providers must use the new CMS 1500 (version 02/12) claim forms when submitting paper claims to insurance companies. Having trouble with your claims? T & T is here to help. Visit the contact us tab for more information!
***UPDATE***President Obama signed into law legislation (HR-4302) that delays the conversion to ICD-10 diagnostic and procedure codes until at least October 1, 2015.
Providers, will you be ready for the transition to the ICD-10 coding system? The compliance date is 10/1/2014. Contact T & T for any questions you may have!
Horizon BCBS has enlisted Value Options to manage their behavioral health program beginning 7/1/2014. If you are a provider currently participating in the Horizon BCBS network there is nothing further for you to do. Your provider file will be transitioned to the Value Options system automatically. If you are currently participating in the Value Options network there is nothing further for you to do. If you are not a Value Options provider you will need to be credentialed in order to continue seeing Horizon BCBS patient. Horizon BCBS patients will need authorization for behavioral health services starting July 2014. Claims will continue being processed by Horizon BCBS.
I have had many telephone calls and posts to my blog entries from providers looking for their credentialing information or claim status. These blog post are from T & T Medical Billing. We are a billing service for mental health providers. This blog section is for informational purposes only. We do not handle claim status inquirers from providers that are not our clients nor do we have any status updates for providers on credentialing matters. So sorry for any confusion.
Sorry for the lateness of this post. Effective 1/1/2014, the behavioral health vendor for the Empire Plan of NY will now be managed by Value Options. United will no longer be accepting claims or outpatient treatment requests for dates of service on or after 1/1/2014. Providers, if you currently participate in the Value Options network there is nothing further for you to do. Providers that are currently participating in the United network but not the Value Options network will be invited to join Value Options via a welcome packet. United providers who choose not to participate with Value Options will have a 90 day grace period to transition those patients to participating providers. For more answers to your questions visit http://www.valueoptions.com/providers/Network/Empire/Empire-FAQ.pdf
Beginning in 2013 the reimbursement rate for Medicare providers will increase to 65% of the allowed rates for mental health services. Also, the Medicare deductible for your clients will increase to $147 at the beginning of 2013.
Effective January 1, 2013, Magellan Health Services will no longer require preauthorization or submitting treatment request forms for routine outpatient care for most plans. Magellan hopes to streamline clinical management for outpatient treatment in order to help their members get access to the care they need. This policy does not apply to inpatient, residential or partial hospitalization. For more information and plan exceptions to this new model providers can securely sign into www.magellanhealth.com/provider.
T & T is rolling out it’s first issue of our eNewsletter specifically for our providers. For those that visit the blog but would also like to be on the mailing list for in depth information pertaining to your specialty contact us at [email protected] and in the subject line type eNewsletter and we will add your email address to the mailings. Thank you all in advance for your support!
The psychiatric Current Procedural Terminology (CPT) codes are expected to change January 1, 2013. From the looks of things there will be around a dozen new codes that will replace codes that are currently being used. Most codes will apply to psychotherapy but there are a few that pertain to E/M and medication management for psychiatrists. The updated coding will now be used in all places of service. T & T will have more on these updates as they are released. Visit http://www.psych.org/practice/managing-a-practice/coding–reimbursement/changes-to-psychiatry-cpt-codes in the mean time for more information about these changes.
UPDATE: Here is the link to the published 2013 CPT codes for mental health providers http://www.apapracticecentral.org/reimbursement/billing/psychotherapy-codes.pdf. T & T will be sending out a detailed newsletter later this year to our providers outlining the codes with descriptions on how to best utilize the new codes for maximum reimbursement from insurance companies. Providers will want to contact the provider relations department at the insurance companies where they participate to get updated fee schedules for their contracts.