Mental Health Insurance

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Changed Mental Health Diagnosis in October 2018

Saturday, January 19th, 2019

 Code to use through 9/30/18 from 10/01/18 Factitious Disorder Imposed on Another F68.10 F68.A Cannabis Withdrawal, With moderate or severe use disorder F12.288 F12.23 Cannabis Withdrawal, Without use disorder Not in DSM-5 F12.93 Opioid Withdrawal, Without use disorder Not in DSM-5 F11.93 Sedative, Hypnotic, or Anxiolytic Withdrawal, w/o  perceptual disturbances Not in DSM-5 F13.939 Sedative, […]

2018 Insurance Changes

Friday, February 16th, 2018

1) Optum will no longer be providing the behavioral health network for Tricare effective January 1, 2018.  On Jan 1, 2018. the TRICARE West Region contract is transitioning to a new managed care contractor, Health Net Federal Service (HNFS). Their website is www.tricare-west.com. 2) CHIPA no longer manages the MHN contract.  Maybe now providers will […]

ICD10 Changes 2018

Tuesday, February 13th, 2018

Effective October 1, 2017, some of the mental health ICD-10 diagnostic codes in the DSM-5  are changing as part of their annual update.  All providers must use these codes in documentation and for insurance billing, whether they contract with insurance or not.  This year’s coding changes are almost all in the area of substance use disorders, […]

States Reimbursement for TeleMentalHealth

Tuesday, February 13th, 2018

1. Forty-eight states and Washington D.C. reimburse for some form of live video in Medicaid fee-for-service models. The two states that do not have written definitive reimbursement policies are Massachusetts and Rhode Island. 2. Twenty-one states reimburse for remote patient monitoring under Medicaid. 3. Six states — Delaware, Colorado, Minnesota, Texas, Washington and Wyoming — […]

Optum and Tricare in 2018

Saturday, January 20th, 2018

Optum and OptumHealth Behavioral Solutions of California will no longer be providing the behavioral health network for Tricare effective January 1, 2018. On Jan. 1, 2018. the TRICARE West Region contract is transitioning to a new managed care contractor, Health Net Federal Service (HNFS). Their website is www.tricare-west.com. All questions about referrals and authorizations will […]

What’s going on with Magellan/Caloptima Medi-cal?

Friday, August 18th, 2017

First Magellan sent out this email: “Effective July 1, providers should submit all Medi-Cal member claims for services – regardless of the date those services were rendered – to CalOptima”. Then Caloptima came back with; “Magellan has ceased important administrative services it is obligated to provide to Caloptima under contract. Caloptima takes this matter very […]

Lookout for MACRA and Don’t Get MIPS in the Butt

Wednesday, March 8th, 2017

MACRA (Medicare Access and CHIP Reauthorization Act of 2015) was the largest change in how Medicare clinicians were paid. MIPS is a sister program, the “Merit-Based Incentive Payment System” – and both are scheduled to take effect in 2017. MIPS applies to Medicare Part B clinicians, including behavioral health/psychiatry physicians, physician assistants, nurse practitioners, clinical […]

Additional Reimbursements for Prolonged Services

Saturday, November 12th, 2016

Add-on codes for Prolonged Services +99354 and +99355 now apply to prolonged face-to-face outpatient psychotherapy as well as to prolonged face-to-face E/M codes. Use a primary E/M or psychotherapy code, one 99354 (30-74 minutes in addition to the time spent on the initial/primary service) per day and as many units of 99355 as needed to match […]

Use Specific ICD10 Codes when Billing

Thursday, October 6th, 2016

Avoid denials for unspecified codes – Medicare and other commercial carriers have allowed a grace period of one year for non-specific ICD10 codes. That one year grace period ends October 1st, 2016. Make sure to use specific ICD10 codes when billing or documenting, especially if you are using ‘defaulted’ diagnosis codes in your billing system.

CHIPA & CHIPA BEACON Delinquent Payments

Thursday, August 11th, 2016

If you are taking Chipa and Beacon Health Strategies patients, be aware that they are running 90 to 180 days behind on payments. Their payment schedule is already low and now has become very delinquent. Some providers are opting out of their contracts altogether to avoid this drag in cash flow. If you have a […]

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