Mental Health Guidelines and Billing Practices
嚜燐ental Health
Guidelines and Billing
Practices
HP Provider Relations
July 2011
Agenda
每 Session Objectives
每 Outpatient Mental Health
每 Medicaid Rehabilitation Option (MRO)
每 Risk-Based Managed Care (RBMC)
每 Eligibility Inquiry
每 Web interChange and CMS-1500 Billing Guidelines
每 Helpful Tools
每 Questions
2
Mental Health Guidelines and Billing Practices
July 2011
Objectives
At the end of this presentation, providers will understand the
following:
每 Outpatient coverage requirements
每 MRO services
每 Meaning of rolling 12-month period
每 Role of the health service provider in psychology (HSPP)
每 Managed care carve-in
每 How to verify member eligibility
每 How to submit claims via the Web interChange and the CMS1500 claim form
3
Mental Health Guidelines and Billing Practices
July 2011
U d
Understand
t d
Outpatient Mental Health
Mental Health
每 The Indiana Health Coverage Programs (IHCP) under the direction of
the Indiana Administrative Code (IAC) 405 IAC 5-20-8 reimburses for
outpatient
t ti t mental
t lh
health
lth services
i
when
h provided
id d b
by:
? Licensed physicians
? Psychiatric hospitals
? Psychiatric wings of acute care hospitals
? Outpatient mental health facilities
? Licensed psychologists with the HSPP designation
5
Mental Health Guidelines and Billing Practices
July 2011
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