Behavioral Health Aides April 2018

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Overview

• Provider Enrollment • Member Eligibility • Covered Services • Claims and Payment • Additional Resources

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Provider Enrollment

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BHA Enrollment Requirements

Alaska Medicaid is only enrolling certified Behavioral Health Aides (BHA) rendering services through a Health Professional Group (HPGs) and supervised by a licensed physician. BHAs rendering services as clinical associate’s solely through a Community Behavioral Health Clinic (CBHC) and supervised by a licensed clinician will not be enrolled at this time. 7 AAC 70.990(3)

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BHA Enrollment Requirements • Behavioral Health Aides (BHA) must be enrolled as individual providers in Alaska Medicaid • BHAs must meet the following conditions:

– Behavioral Health Aide Levels I, II and III or a Behavioral Health Practitioner – Current certification by the Community Health Aide Program Certification Board – Employed by a tribal organization owned or leased by the Indian Health Service or a tribal organization

with a 638 contract operating a Community Health Aide Program – Supervised by a licensed physician who

• Is enrolled separately with Alaska Medicaid • Is willing to assume professional responsibility for the BHA services • Will ensure that BHA services are medically necessary

Note: If enrolling as a dual certified BHA and CHA/P, provider must meet all BHA and CHA/P enrollment requirements and submit appropriate documentation for both provider types.

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Provider Enrollment

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BHA Provider Enrollment Agreement

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BHA Documentation Requirements All required documentation must be submitted during enrollment to complete the enrollment process as an Alaska Medicaid provider. • A copy of a current certification must be submitted during enrollment • An original signed CHA/P/ DHAT / BHA Provider Enrollment Agreement must also be submitted with

the provider enrollment documentation • Mail all documents to Conduent Provider Enrollment at: Conduent State Healthcare Attn: Provider Enrollment P.O. Box 240808 Anchorage, Alaska 99524-0808 • Upon enrollment approval, Alaska Medicaid will send a letter to the individual BHA confirming their

indicated affiliated health professional group(s) and informing them of their assigned Alaska Medicaid Provider ID

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Enrollment Maintenance Requirements Providers must ensure their certification is kept current and provide appropriate updates to Provider Enrollment to remain actively enrolled. This includes changes to certification levels. • Updates to a provider’s enrollment file must be reported within 30 days of the change

– http://manuals.medicaidalaska.com/docs/enrollmentforms.htm Update Provider Information Request Form

• Mail copies of new or updated documents to Conduent Provider Enrollment at: Conduent State Healthcare Attn: Provider Enrollment P.O. Box 240808 Anchorage, Alaska 99524-0808

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Member Eligibility

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Member Eligibility

Always verify member eligibility by using one of the following options: • Request to see the member's eligibility coupon or card that shows the current month of eligibility;

photocopy for your records • Call Automated Voice Response System (AVR):

– 855.329.8986 (toll-free) • Verify via Alaska Medicaid Health Enterprise website

– http://medicaidalaska.com • Fax complete Member Eligibility Inquiry Form • 907.644.8126 • Submit a HIPAA compliant 270/271 electronic Eligibility Inquiry transaction • Call Provider Inquiry

– 907.644.6800, option 1 or 800.770.5650, option 1, 1 (toll-free)

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Covered Services

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BHA Services BHA services are only reimbursed for specific procedure codes approved by the Community Health Aide Program Certification Board and State of Alaska. • Two BHA Service Categories

– Professional Services through a Health Professional Group (HPG) – Behavioral Health Services through a Community Behavioral Health Clinic (CBHC)

• Covered procedure code listing located: – On the Alaska Medicaid website at http://medicaidalaska.com under Documentation, then Documents

& Forms, click on Fee Schedules – Tribal Billing Manual (Appendix G)

• BHAs may practice only under the supervision of a licensed physician in an HPG or as a clinical associate in a CBHC.

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Supervision & Telemedicine Services The BHA scope of practice is limited; therefore questions regarding treatment or diagnosis outside of the treating BHA’s scope of practice must be addressed first with the BHA’s supervising physician.

– Physician supervision of a BHA is not separately reimbursable by Alaska Medicaid. – A BHA request for supervision is not separately reimbursable by Alaska Medicaid.

In the event the BHA’s supervising physician determines that consultation with another provider at a higher level and/or different specialty is medically necessary, the BHA’s supervising physician will order the consultation. • Consultation may occur in-person or via telemedicine (interactive only) and must meet all components of

the procedure code billed for consultation. • The initial examination performed by a BHA, prior to the telemedicine session, may be reimbursed for the

specific procedure provided by the BHA.

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Provider Billing Manuals Billing manuals are available at http://manuals.medicaidalaska.com.

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Recordkeeping • Recordkeeping requirements are documented in the Individual Provider Agreement and Tax

Certification and Group Provider Agreement and Tax Certification • Although most recordkeeping requirements are consistent for all providers, some requirements are

provider-type specific • Providers must maintain complete and accurate clinical, financial, and other relevant records to

support the care and services for which they bill Alaska Medicaid for a minimum of 7 years from the date of service

• Providers are subject to audits, reviews and investigations

Providers must ensure their staff, billing agents, and any other entities responsible for any aspect of records maintenance meet the same requirements.

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Claims and Payment

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BHA Services Billing

BHA services are billed using the Professional Format

• Alaska Medicaid Health Enterprise • 837P Transaction (electronic claim using billing software)

– Companion Guide: http://medicaidalaska.com – Implementation Guide (referred to as TR3): http://www.wpc-edi.com

• Payerpath (electronic claim) • CMS-1500, Professional Health Insurance Claim Form (paper claim)

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BHA Services Billing

BHA services must be rendered and billed through the appropriate entity to be considered for reimbursement.

• BHA services rendered through a Community Behavioral Health Clinic (CBHC) should be billed using standard CBHC billing procedures for all other rendering provider types.

• To bill BHA services rendered through a Health Professional Group (HPG), enter: – Itemized services in field 24d (refer to BHA covered codes) – Rendering BHA’s NPI number in field 24j – BHA’s credentials in field 31 with signature – Billing provider’s NPI in field 33a (HPG the BHA is affiliated to) – Billing provider’s taxonomy care preceded by qualifier ZZ in field 33b – If HPG covered BHA services in multiple locations, use HPG address as servicing address

BHA services cannot be billed using a provider ID for a Tribal Clinic provider type or any other tribal facility. They must be billed using the supervising physician’s affiliated HPG NPI that has assumed responsibility for the services or affiliated CBHC NPI.

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Timely Filing

BHA services are not payable by Medicare or any other insurance carrier and should be billed directly to Alaska Medicaid for reimbursement consideration. • All claims must be filed within 12 months of the date you provided services to the member

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Reimbursement Methodology

BHA services are reimbursed using the encounter rate reimbursement methodology. • Services rendered through an HPG qualify for the encounter rate set by the Office of Rate Review • Services rendered through a CBHC qualify for the behavioral health encounter rate • Payment for BHA services will be made to the HPG or CBHC billing for services

– BHAs cannot be paid directly

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Additional Information

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Additional Resources

Alaska Medicaid Health Enterprise website at http://medicaidalaska.com. • Information necessary for successful billing • Includes provider-specific Medicaid billing manuals and fee schedules You may also call: • Provider Inquiry

– Eligibility only – 907.644.6800, option 1,2 or 800.770.5650 (toll-free), option 1,1,2 – Claim status and other inquiries – 907.644.6800, option 1,1 or 800.770.5650 (toll-free), option 1,1,1

Conduent Enhanced Provider Services – Tribal Specialist – Office: 907.644.6805 – Fax: 907.644.9845

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