Licensed Professional Counselors. Introduction to Blue Cross and Blue Care Network
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1 Licensed Professional Counselors Introduction to Blue Cross and Blue Care Network Blue Cross / BCN Provider Outreach December 2015 / January 2016
2 Purpose of meeting Explain the changes affecting licensed professional counselors, including billing requirements Show how to become a Blue Cross / BCN provider, including how to sign up for our electronic systems IMPORTANT: This information does not apply to LPCs who currently practice in a substance abuse facility or outpatient psychiatric facility (OPC) and who will continue to do so. This information does apply to LPCs who now practice or want to practice in an individual or group practice setting. 2
3 3 Introduction to upcoming changes for LPCs
4 What s changing? What s new? Starting Jan. 1, 2016, Blue Cross and BCN will accept claims directly from enrolled LPCs and will reimburse LPCs directly... and LPCs enrolled with Blue Cross / BCN will appear in our online provider search. Currently, an LPC s services are reimbursable only when billed under another provider (in an office setting) or when billed by a substance abuse facility / OPC. 4
5 What s changing? Who should enroll? Who should enroll as a Blue Cross or BCN provider? If you want to be reimbursed directly for your services to Blue Cross / BCN members rather than bill under a supervising provider, you should enroll as a Blue Cross or BCN provider. We ll show you how to enroll in later slides. If you re seeing our members in an OPC, you do not need to enroll. 5
6 What s changing? Please note This change may not apply to some groups. Always check the member s benefits. Note: You ll do that using our web-denis system. In later slides, we ll show you how to sign up for web-denis. 6
7 7 Some important differences between Blue Cross and Blue Care Network
8 Blue Cross / BCN comparison Blue Cross / BCN similarities and differences QUESTION Blue Cross BCN 1 What is Blue Cross / BCN? Nonprofit mutual insurance company Health maintenance organization 2 Which provider networks are now accepting LPCs? Note: The Medicare Plus Blue SM Preferred Provider Organization network is not open to LPCs. Largest health insurer in Michigan Traditional TRUST PPO Mental Health and Substance Abuse Managed Care Wholly owned subsidiary of Blue Cross Blue Shield of Michigan BCN HMO SM (commercial) BCN Advantage SM 8
9 Blue Cross / BCN comparison Blue Cross / BCN similarities and differences QUESTION Blue Cross BCN 3 Starting Jan. 1, 2016, can LPC services still be billed under an MD/DO or fully licensed psychologist? Yes Through Dec. 31, 2015: LPCs can bill under a fully licensed psychologist for services to BCN members. Starting Jan. 1, 2016: LPCs can no longer bill under a supervising provider for services to BCN members. 4 Can LPCs contract as individual providers? 5 Can LPCs still practice in a substance abuse facility or an OPC setting? Yes Yes Through Jan. 31, 2016: Yes. LPCs can apply to contract with BCN as individual providers. Starting Feb. 1, 2016: No. LPCs can apply to contract as BCN providers only as part of an existing group practice. Network need criteria apply. Yes 9
10 10 Provider requirements
11 Blue Cross provider requirements Blue Cross requirements by provider type Title of state-licensed rendering provider* Direct participation Billing provider Psychiatrist Fully licensed psychologist Yes Yes Limited licensed psychologist No May be supervised by a fully-licensed psychologist Clinical licensed Master s-level social worker Yes No Licensed professional counselor Yes, eff. 1/1/16 May be supervised by an MD/DO or fully-licensed psychologist No May be supervised by an MD/DO or fully-licensed psychologist Licensed marriage and family therapist No Supervising MD/DO or fully-licensed psychologist Board-certified behavior analyst RN with specialty certification as a nurse practitioner Yes Yes No May be supervised by an MD/DO or fully-licensed psychologist Physician assistant No Supervising MD/DO *When professional providers render services in a facility location of service, the facility is the billing provider. The license of the profession titled "limited licensed psychologist" is NOT a limited license for the purpose of obtaining postdoctoral training. A limited licensed psychologist has completed his/her education and practices as Master's-level limited licensed psychologist. A "temporary limited licensed psychologist" is completing the post-educational experience to become a limited licensed psychologist. Not licensed by the state of Michigan. BCBSM requires certification from the Behavior Analyst Certification Board, Inc. 11
12 BCN provider requirements What are BCN s requirements for LPCs? 12
13 BCN provider requirements What are BCN s provider requirements? Does the BCN requirements document cover supervision? Yes, but only for billing purposes. For supervision of clinical work with patients, you need to follow the requirements set out by your state-issued license or registration. This includes the minimum number of supervision hours, the proximity of the supervisor to the treating practitioner and the keeping of notes / records. Resource: State of Michigan Department of Licensing and Regulatory Affairs (LARA) Bureau of Professional Licensing (517) or BPLHelp@michigan.gov 13
14 BCN provider requirements Where can I find the BCN requirements document? 1. Go to ereferrals.bcbsm.com. 2. Click Behavioral Health. 3. Click to open the BCN requirements document. 14
15 Transitioning BCN authorizations What about current BCN authorizations? If you are providing services to BCN members under a supervising provider in a solo or group practice, BCN will honor all authorizations for LPC services provided under a fully-licensed psychologist for the date range of the authorization. If you are submitting a Behavioral Health Continuing Outpatient Treatment Request Form (OTR) for additional sessions within the same date range of a current authorization and want the authorization transferred to you rather than go to the supervising provider, please make a note of this on the OTR. o o When your contract is confirmed, the authorization will be transferred to you going forward. If your contract is not confirmed, the authorization will continue to go to the supervising provider until the end date of that authorization. 15
16 Questions? If you have questions and are already enrolled as a Blue Cross or BCN provider, you can contact your provider consultant. To find out who your provider consultant is, go to bcbsm.com/providers and 1. Click Contact Us. 2. Click the link for the Blue Cross or BCN provider contacts. 3. Click Provider consultants and then click the appropriate regional list. 16
17 17 QUESTIONS?
18 18 How to become a Blue Cross or BCN provider
19 Becoming a provider Three steps To become a Blue Cross or BCN provider you must do three things 1. Enroll 2. Be credentialed 3. Sign the contract We ll show you how to do that, but 19
20 Becoming a provider Defining some terms 20 First, let s define the terms you ll need to know o o o o Individual (solo) practitioner: An individual who practices independent of a group (does not have a Type II organizational National Provider Identifier) Group: Bills with a Type II organizational NPI in a professional group in which there is more than one practitioner OPC: A facility contracted as a freestanding outpatient psychiatric care facility by Blue Cross / BCN. These facilities are listed as outpatient psychiatric centers in the online Blue Cross / BCN provider search. You can also contact your facility s administrator to confirm. Incorporated individual practitioner: Bills with a Type II NPI but is the only practitioner in the group Now, let s go through the steps for becoming a Blue Cross or BCN provider.
21 Step 1 - Enroll How to enroll Visit bcbsm.com/providers. 21
22 Step 1 - Enroll How to enroll 22
23 Step 1 - Enroll How to enroll 23
24 Step 1 - Enroll Various scenarios To add the LPC to an existing group A To enroll the LPC as a solo practitioner (Type I NPI only) B To enroll the LPC as an incorporated individual (Type II NPI) C 24
25 Step 1 - Enroll Scenario A SCENARIO A To add the LPC to an existing group. 1 Note: Use this form to sign up for Provider Secured Services. That will give you access to the web-denis system. 2 Note: You ll have to complete a CAQH application after you re done with the enrollment process. It s part of the credentialing process. We ll tell you more about that later, too. 25
26 Step 1 - Enroll Scenario A SCENARIO A To add the LPC to an existing group. 3 IMPORTANT: On this form, select which Blue Cross participation agreement(s) you want. Sign the form and return it. Read the applicable Blue Cross agreements and file them for future reference. Note: For BCN, the group administrator uses the Group Change Form (see previous slide) to request provider additions and network changes. 26
27 Step 1 - Enroll Scenario B SCENARIO B To enroll the LPC as a solo practitioner (Type I NPI only) 1 Note: Use this form to sign up for Provider Secured Services / web-denis. CAQH application 27
28 Step 1 - Enroll Scenario B SCENARIO B To enroll the LPC as a solo practitioner (Type I NPI only) 2 Read the Blue Cross agreements and file them for future reference. Select the appropriate agreement(s) on the combined signature document, sign the document and return it. 3 Read the BCN agreements and file them for future reference. Sign the appropriate signature document(s) and return them. 28
29 Step 1 - Enroll Scenario C SCENARIO C To enroll the LPC as an incorporated individual (Type II NPI) 1 Note: Use this form to sign up for Provider Secured Services / web-denis. CAQH application 2 29
30 Step 1 - Enroll Scenario C SCENARIO C To enroll the LPC as an incorporated individual (Type II NPI) 3 IMPORTANT: On this form, select which Blue Cross participation agreement(s) you want. Sign the form and return it. Read the applicable Blue Cross agreements and file them for future reference. IMPORTANT: For Blue Cross, also sign this form and return it. For BCN, you ll receive the agreements via . 30
31 Step 2 Be credentialed Credentialing follows enrollment All enrolled LPCs must be credentialed. The credentialing process starts when you fill out a CAQH application, which must be completed within 14 calendar days of the date you submitted your enrollment request. The instructions are at proview.caqh.org/pr There is only one credentialing process for BCBSM and BCN. 31
32 Step 3 Contract Final step: The contract Enrolled LPCs will receive countersigned contracts with a welcome letter and an effective date. 32
33 Keeping current Keep your information updated You must update your CAQH information every 120 days. Visit proview.caqh.org/pr. If your demographic information changes, update it with CAQH within 30 days of the change. All other changes should be submitted to Blue Cross / BCN Provider Enrollment and Data Management. 33
34 34 Blue Cross / BCN electronic systems
35 web-denis What is web-denis for? You ll use web-denis to check a member s eligibility and benefits at each visit. You signed up for web-denis when you completed the New Mental Health Practitioner Enrollment Form. Note: Use this form to sign up for Provider Secured Services / web-denis. 35
36 Sign up to use BCN s e-referral system How to sign up for e-referral BCN providers use the e-referral system to submit requests to authorize services. To sign up, go to ereferrals.bcbsm.com and click Sign Up or Change a User. Follow the instructions there. 36
37 Guide for using BCN s e-referral system How to use e-referral At ereferrals.bcbsm.com, click Training Tools. Click to open the e-referral User Guide. Look in the Behavioral Health section of that guide to see how to submit authorization requests and check the status of your requests. 37
38 Provider Secured Services Log in to Provider Secured Services Both web-denis and BCN s e-referral system are part of Provider Secured Services. Once you have a Provider Secured Services user ID and password, visit bcbsm.com/providers and log in as a provider. 38
39 Opening the systems On the Provider Secured Services Home page, you can click to access web-denis (for both BCBSM and BCN providers) and BCN s e-referral system. 39
40 40 QUESTIONS?
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