To assist in this effort, you may be asked to complete a Clinical Update Request Form which will be included in the initial notification or asked to complete the form(s) which were previously submitted incompletely. How Does This Affect Providers?For dates of service beginning on or after June 1 for Blue Essentials and Blue Premier members: How Does This Affect Members?We will notify Blue Essentials and Blue Premier members before the transition date. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, These guidelines are designed to assist clinicians by providing a framework for evaluation, and treatment of patients and is not intended to either replace a clinicians judgment or establish a protocol for all patients with a particular condition. You can also find: To get help choosing a plan, call1-866-875-1375. Medicare supplement plansdon't include Part D prescription drug coverage. Menominee County 401 Tenth Ave. Menominee, MI 49858. Refer to important information for our linking policy. This will help you confirm coverage details and other important information, including prior authorization requirements. Register Now, Not registered? You can decide what plan is best for you: You could start by talking about mental health with your primary care provider (PCP). It will open in a new window. Behavioral Health providers have contractually agreed to offer appointments to our members according to the following appointment access standards: Initial/Routine Care: Within 10 working daysFollow-up for Routine Care: Within 1-3 monthsUrgent: Within 48 hoursNon-life threatening emergency: Within six (6) hoursLife threatening/emergency: Within one (1) hour or refer immediately to ER. Blue Cross and Blue Shield of Texas (BCBSTX) will be sending out notifications for new PA exemptions for the Jan-June 2023 review period by Sept. 1. Psychological and Neuropsychological Testing, in some cases (BCBSIL will notify the provider if benefit prior authorization is required for these testing services). Contact Magellan Health Services or call 1-800-788-4005 If you have any questions about the products or services provided by the vendor, you should contact the vendor directly. Copyright document.write(new Date().getFullYear()) Health Care Service Corporation. If you have any questions about the CPGs adopted by BCBSTX, email us at BH Quality Improvement. Prior Authorization Managed by BCBSTX: Use Availity Authorization & Referrals tool; Call 1-800-528-7264 or the number listed on the back of the member ID card. Refer to important information for our linking policy. The Behavioral Health Care Management page on the provider website provides additional information on the BCBSTX programs. Magellan Behavior Health Services coordinates all behavioral health (mental health and chemical dependency) services for Medicaid (STAR) and CHIP members. an Independent Licensee of the Blue Cross and Blue Shield Association. The new Texas Clinicians Postpartum Depression Toolkit is intended to be a resource for Texas clinicians on screening, diagnosis and treatment of postpartum depression. Benefits will be determined once a claim is received and will be based upon, among other things, the members eligibility and the terms of the members certificate of coverage, including, but not limited to, exclusions and limitations applicable on the date services were rendered. an Independent Licensee of the Blue Cross and Blue Shield Association. When you reach a certain amount, we pay for most covered services. The Program also allows the BH team to "touch" every member who utilizes BH services via our state-of-the-art analytics to identify those who could potentially benefit from our array of programs and services. The Behavioral Health program provides BCBSTX members a wide range of services, including: , , , , , , Environmental, Social and Governance (ESG), HVAC (Heating, Ventilation and Air-Conditioning), Machine Tools, Metalworking and Metallurgy, Aboriginal, First Nations & Native American, It's Men's Health Month: Forget the lawn, see a doc and kickstart your health journey, Blue Cross and Blue Shield of Texas launches MyBlueRxTX mobile pharmacy benefit app, supporting local non-profits through BCBSTX Blue Impact grants. Behavioral Health for Other BCBSTX Plans (Note: for ERS or TRS participants refer to specific form links above) Form Description; Applied Behavior . To assist in this effort, you will be asked to complete a Clinical Update Request Form which will be included in the initial notification. Some of these plans also cover preventive dental, vision and hearing costs. This is a solicitation of insurance. Instead, we have two programs where we use our proprietary clinical analytics to touch every routine service without requiring the overly burdensome practice of prior authorization. Headway also stated that 76 percent of BCBSTX members see an improvement in a clinical assessment in the first 30 days. Register Now, Not registered? These routine services are, however, managed by the Focused Outpatient Management Program portion of our Outpatient Management Program which is described in more detail later in this document. Prior authorization for these services requires completion of a form(s) located on bcbstx.com/provider. How to Request Prior Authorization or Prenotification and View Dickinson County 715 Pile Drive. A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, Living with Mental Health Learn More Understanding Behavioral Health Learn More Understanding Bipolar Disorder Learn More Understanding Depression and Anxiety Learn More With nearly 4,000 Headway providers now in-network, BCBSTX members receiving 2-3x faster access to first appointment. Our Psychological/Neuropsychological Testing Clinical Payment and Coding Policy is available as a reference on the Clinical Payment and Coding Policy page. We owe that to our members.". The initial pre-authorization process will be utilized to confirm: As part of the initial pre-authorization process, the provider must submit a packet of three (3) ABA forms (Diagnostic Physician/Specialist Evaluation; Provider Credentials Verification; Assessment Info & Initial Treatment Plan) to confirm the above requested information. Learn more, Our Behavioral Health team follows members as they step down from intensive inpatient, residential or partial hospitalization to less intensive levels of care (outpatient). Legal and Privacy Our Medicare Advantage plans use copays for most services. Learn more. They're only available through private health insurance companies, like Blue Cross. Headway is now available to fully-insured group plans both in Illinois and Texas. Some plans cover more drugs than others. Important Legal and Privacy Information|Important Information About MedicarePlans|Privacy Practices|Site Map|Feedback|Download Adobe Acrobat Reader, Y0074_BCBSMBCNWeb_M_2023_C CMS Accepted 04232023, Page Last Updated Tue Jul 18 20:07:10 EDT 2023. Once the initial pre-authorization process has been completed, the provider may initiate ABA services for the member. You can pay your monthly premium for your Medicare Advantage or Part D plan online. These routine services do not require pre-authorization under the BH Outpatient Management Program. We provide health insurance in Michigan. If BCBSTX is unable to determine that these services meet the criteria for medical necessity as outlined in the members benefit plan, the member may be financially responsible for those services. Our network boasts 80,000 doctors in Michigan and 1.7 million doctors nationwide. Checking eligibility and/or benefit information and/or the fact that a service has been prior authorized/pre-notified is not a guarantee of payment. Please email womenshealth@hhsc.state.tx.us with any questions. In addition to the provider outreach and collaboration described above, BCBSTX will also send a letter to the member to inform him or her that their provider has been asked to provide clinical information to BCBSTX to ensure the member is getting medically necessary and appropriate quality care and treatment. "We always want to improve access to behavioral health care it's extremely important. As a result, authorization for continued services may be discontinued and the member may be financially responsible. It covers commonly used brand-name and generic drugs. If BCBSTX is unable to determine that these services meet the criteria for medical necessity as outlined in the members benefit plan, the member may be financially responsible for those services. If you have any questions, call the number on the members ID card. When typing in this field, a list of search results will appear and be automatically updated as you type. Blue Cross PPO, answered by New Directions: 1-877-627-1041 . Category F (F01-F99): These codes include disorders of psychologicaldevelopment. an Independent Licensee of the Blue Cross and Blue Shield Association. For BCBSTX members that live out of state, there are more than 21,000 high-quality credentialed behavioral health providers now in-network across 26 states practice as a part of the Headway network, with 42 percent of providers identifying as Black, Hispanic, Asian or multiracial and more than 80 languages spoken. Behavioral Health Care Management Program | Blue Cross and Blue Shield BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. To get help choosing a plan, call 1-866-875-1375. The purpose of the clinical review is to discuss the current treatment plan and to identify and address the appropriate level, intensity and duration of the outpatient treatment needed. . If you have any questions about the CPGs adopted by BCBSTX, email us at BH Quality Improvement. Behavioral Health: Mental Health and Substance Use Disorder. All Rights Reserved. PDF BEHAVIORAL HEALTH - eauth.bcbstx.com It will open in a new window. Clinical analytics are designed to trigger cases that are outside of the reasonable expectations for active treatment, and the cornerstone of this model is outreach and engagement from our behavioral health clinicians to the identified providers for a clinical review. A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. Health Care Provider Forms - Blue Cross and Blue Shield of Texas - BCBSTX TTY users dial711. All behavioral health benefits are subject to the terms and conditions as listed in the member's benefit plan. Reminder: BCBSTX Prior Authorization Exemption Communication Method It will open in a new window. PDF Behavioral Health - HMO Manual - eauth.bcbstx.com These intensive services are: To determine benefit coverage prior to the service and to determine if prior authorization for these intensive outpatient services are required by a specific employer group, members or providers should call the prior authorization MH/SUD number listed on the back of their ID card or the BCBSTX BH Call Center at 1-800-528-7264. Form Description; Applied Behavior Analysis (ABA) forms: TRS ABA Clinical Service Request Form ; TRS ABA . To return to our website, simply close the new window. We may contact you about buying insurance. Get access to your provider portal.Register Now, Not registered? Behavioral Health Program Components: Inpatient Management for inpatient, partial hospitalization, and residential treatment center (RTC) services. Our program includes a portfolio of resources to help our members access benefits for behavioral health (mental health and substance abuse) conditions as part of an overall care management program. When time is critical, and someone needs help, making it fast and simple to see a provider for that first appointment is a top goal," said Dr. Frank Webster, BCBSTX's chief medical officer for behavioral health. Call the number on the member ID card for details. All behavioral health benefits are subject to the terms and conditions as listed in the members benefit plan The Behavioral Health program is available only to those members whose health plans include behavioral health benefits through BCBSTX. Magellans PCP toolkit represents Magellans commitment to promote integration of medical and behavioral health services toward the goal of better overall outcomes for patients. Non-Discrimination Notice. The provider will be directed to complete the required preauthorization process, and a retroactive review may be required. Benefits will be determined once a claim is received and will be based upon, among other things, the members eligibility and the terms of the members certificate of coverage applicable on the date services were rendered. Clinical information provided will be reviewed by Behavioral Health clinical staff for further recommendations and determination of coverage based on member benefit plans. Guidelines for the use of Psychotropic Medication Management are included within each Behavioral Health Clinical Practice Guideline. This link will take you to a new site not affiliated with BCBSTX. All providers on behalf of the member are required to notify BCBSTX of a request to provide ABA services for members. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly. It will open in a new window. The toolkit includes coverage and reimbursement options for postpartum depression through Medicaid, CHIP, the Healthy Texas Women Program, the Family Planning Program and other referral options. Magellan manages the following HMO plans: Blue Advantage HMOSM and Blue Advantage PlusSM MyBlue HealthSM Blue Cross Medicare Advantage (HMO)SM The following plans are managed by BCBSTX Medical Management: A Medicare supplement plan might be a good choice for you if you already have prescription coverage through an employer or military benefits. Call the number on the back of the member's ID card to find outpatient providers or behavioral health facilities. It includes medical coverage and may include prescription drug coverage. Legal and Privacy Behavioral Health Services are provided by Magellan Health Services. And if you're in the hospital or a skilled nursing facility, Original Medicare only pays for a certain number of days. Behavioral Health Outpatient Management Program The Blue Cross and Blue Shield of Texas (BCBSTX) Behavioral Health (BH) Outpatient Management Program includes the management of intensive and some routine outpatient services. Cision Distribution 888-776-0942 Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. During each episode of authorized treatment, the BH Outpatient Management team may outreach to the provider to participate in the concurrent review process. Behavioral Health Quality Improvement (BH QI) department continually monitors and evaluates the Behavioral Health Care Management program for BCBSTX. BCBSTX also supports initiatives to improve mental health for members and people in the communities it serves by: Watch this messagefrom BCBSTX's Chief Medical Officer Dr. Mark Chassay about the importance of seeking behavioral health care. These plans are also only available through private health insurance companies. After the . Blue Cross Blue Shield of Michigan is here to offer the support you need to . If a professional provider has a patient who may benefit from participating in one of the above mentioned programs, please call Behavioral Health Member Services using the number on the back of the Members ID card to have the patient screened and considered for enrollment in a Case Management Program. This structure allows the BH team to follow/monitor members as they step down from intensive levels of care (inpatient, residential, partial hospitalization) to less intensive levels (intensive outpatient, routine outpatient), ensuring that they have access to the most appropriate and effective treatment. It includes management of intensive and some routine outpatient services. The initial treatment plan meets medical necessity. Magellan Behavior Health Services coordinates all behavioral health (mental health and chemical dependency) services for Medicaid (STAR) and CHIP members. So, you can be confident you're covered with a Blue Cross Medicare plan. However, services rendered by out-of-network providers may be denied, impacting the members cost share responsibilities. All Rights Reserved. There are two primary categories under the ICD-10 code guidelines for behavioral health: F and Z. Behavioral Health Care Management Program - BCBSTX The Behavioral Health Program is designed to help reduce administrative burden and improve collaboration and provider satisfaction, while also helping to ensure members get the right care at the right place and time. Health Care Provider Forms - Blue Cross and Blue Shield of Texas Home Copyright document.write(new Date().getFullYear()) Health Care Service Corporation. This program is a claims-based approach to touch all routine cases through clinical logic. In addition, BCBSTX is focused on making behavioral health care more accessible through increased access to telehealth overall. The change began with the COVID-19 pandemic, after BCBSTX expanded its behavioral health care offerings by broadening access to virtual appointments, and as more people sought alternatives to in-person care in the wake of the pandemic. Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. Educational Webinar Sessions - Blue Cross and Blue Shield of Texas Legal and Privacy Blue Care Network HMO: 1-800-482-5982. Hospital costs after you run out of Medicare-covered days, Skilled nursing facility costs after you run out of Medicare-covered days. At Blue Cross, we have more than 80 years of insurance expertise that you can rely on. The Behavioral Health Program also allows the Behavioral Health team to touch every member who uses behavioral health care services via our state-of-the-art analytics to identify those who could potentially benefit from our array of programs and services. A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, Behavioral Health | Blue Cross and Blue Shield of Texas Important Information About MedicarePlans. Sign up to get PRNs top stories and curated news delivered to your inbox weekly! We can help you find a behavioral health specialist or treatment center, depending on your needs. The benefit of the full Behavioral Health Program inpatient and outpatient management is that it allows our Behavioral Health team to assist members throughout the entire continuum of their behavioral health care and treatment. All-in-one dental coverage including crowns, fillings, extractions and other restorative services. BCBSTX is accountable for performance on national measures, like the Healthcare Effectiveness Data and Information Sets (HEDIS). BCBSTX Provider Network Expansion Improves Behavioral Healthcare Access Learn more, The BCBSTX Behavioral Health team uses nationally recognized, evidence-based and/or state or federally mandated clinical review criteria and issue prior authorizations for all behavioral health clinical decisions. For most services, you'll pay the full cost until you reach the deductible. . Until 2020, telehealth represented one half of 1 percent of all BCBSTX members' behavioral health appointments. To return to our website, simply close the new window. Get access to your agent portal.Register Now. To determine benefit coverage prior to the service and to determine if preauthorization for intensive outpatient services are required by a specific employer group, members should call the preauthorization MH/SA number listed on the back of their ID card or the BCBSTX BH Call Center at 800-528-7264. Routine behavioral health outpatient services (individual, family, group psychotherapy, psychiatric medication management) do not require prior authorization. Our Behavioral Health Care Management program is accredited for Health Utilization Management. June 08, 2023 - Blue Cross and Blue Shield of Texas (BCBSTX) is improving behavioral healthcare access for members with an expanded provider network and additional telehealth offerings. Availity provides administrative services to BCBSTX. Refer to important information for our linking policy. The Behavioral Health Care Management Programs offered by BCBS serve members suffering from Depression, Alcohol/Substance Abuse Disorders, Anxiety/Panic Disorders, Attention Deficit/Hyperactivity Disorder, Bipolar Disorder, Eating Disorders, Schizophrenia and other Psychotic Disorders. Intensive outpatient services are managed by prior authorization and concurrent reviews. Behavioral Health Care Management Program, Pre-cert/Pre-auth Router (out-of-area members), Preventive Care Guidelines/Patient Wellness Guidelines, Behavioral Health Utilization Management Program Overview, Schizophrenia and other Psychotic Disorders, Attention Deficit and Hyperactivity Disorder (ADD/ADHD), Referrals to other medical management programs, and wellness and prevention campaigns. Some members may not have outpatient behavioral health management. Medicare Plus Blue PPO: 1-888-803-4960. We do not expect member benefits to be affected by this change. Many of our plans offer $0 premiums, $0 deductibles and $0 primary care copays, while others combine medical and dental coverage. What do Medicare Parts A, B, C and D mean? Plans with $0 premiums, $0 deductibles and $0 primary care copays. A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, BCBSTX will review the information provided for further recommendations and make a determination of coverage based on member benefit plans. Instead, these plans cover the costs you're responsible for with Original Medicare. The cornerstone of this model is outreach and engagement from BCBSTX BH clinicians to the identified providers and members to discuss treatment plans and benefit options. They also have classification designations such as: With or without behavioral disturbance Complicated or uncomplicated In remission With withdrawal It will open in a new window. How do copays, coinsurance and deductibles work with Medicare plans? Magellans Medical Providers Behavioral Health Toolkit gives medical practitioners the information and screening tools needed to assist in making behavioral health referrals. It will open in a new window. There are four parts of Medicare. Members can schedule care directly in as soon as 48 hours viaa one-click booking experience at headway.co or can obtain care through a referral. URAC offers a wide range of quality benchmarking programs and services that keep pace with the rapid changes in the health care system, and provide a symbol of excellence for organizations to validate their commitment to quality and accountability. Psychological and Neuropsychological Testing in some cases (BCBSTX will notify the provider if preauthorization is required for these testing services). Behavioral Health Quality Improvement Program | Blue Cross and Blue Get access to your online account. Behavioral Health Care Management Program, Pre-cert/Pre-auth Router (out-of-area members), Preventive Care Guidelines/Patient Wellness Guidelines, Expectation that member has a follow up appointment with a behavioral health professional following a mental health inpatient admission within 7 and/or 30 days, For members treated with Antidepressant medication, Medication Adherence for 12 weeks of continuous treatment (during Acute phase), Medication Adherence for 180 days (Continuation phase), For children (6-12 years old) who are prescribed ADHD medication, One follow up visit the first 30 days after medication dispensed (Initiation phase), At least two (2) visits, in addition to the visit in the initiation phase with provider in the first 270 days after Initiation phase ends (Continuation and Maintenance phase). The provider can contact the BH Outpatient Team at any time for clarification of the process at the BH Call Center.