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Enhanced Medicaid Payment for Psychiatric Services Provided Within Community Mental Health Centers

Posted January 30, 2017

In accordance with the Illinois Department of Healthcare and Family Services (HFS) Medicaid enhanced payments for specific psychiatric and behavioral health services, Blue Cross and Blue Shield of Illinois (BCBSIL) has updated its claim processing system to comply with the physician and the community mental health center (CMHC) notices that were issued by HFS. 

The psychiatric services qualifying for the enhanced payments, must have a date of service between July 1, 2016, and June 30, 2017, and must have been rendered by a physician or an advanced practice nurse in a CMHC. 

In order to receive the eligible enhanced payments for psychiatric services, claims must be submitted with the appropriate procedure code, including the UB modifier, as supported by the documentation in the medical record, and must designate the CMHC as the billing provider/payee. Some codes to which this applies can be found at the following links:

If you filed a claim without using the revised guidelines and with a date of service on or after July 1, 2016, you should submit a corrected claim with the applicable procedure code including the UB modifier and designating the CMHC as the payee. For dates of service prior to Oct. 13, 2016, you must submit claims no later than April 15, 2017. For dates of service on or after Oct. 13, 2016, you must submit claims within 180 days from the date of service.

For claims submitted or already resubmitted using the revised guidelines, no additional action is required. BCBSIL will run a report of impacted claims and adjust any that processed prior to the system configuration update.

If you have any questions and/or concerns regarding claims submissions for the psychiatric services qualifying for the enhanced payments, please contact your Provider Network Consultant.

For additional information, please reference the following provider notice from HFS: illinois.gov/hfs/MedicalProviders/notices/Pages/prn161019a.aspx.