Harvard Pilgrim Changes

Effective Jan. 1, 2025, non-contracted Harvard Pilgrim providers will no longer be considered IN network. Providers were considered participating if the provider was IN network with Optum/United Behavioral Health’s network. Harvard Pilgrim invites Optum/United providers that are seeing Harvard Pilgrim clients to join the Harvard Pilgrim network at https://www.harvardpilgrim.org/provider/resource-center/join-our-network/

BCBS of Michigan network participation changes for 2025

Starting Jan. 1, 2025, Blue Cross Blue Shield of Michigan and Blue Care Network will disenroll health care providers who haven’t submitted any claims for 24 consecutive months. Disenrollments will occur automatically and will be carried out on a quarterly basis. Blue Cross Blue Shield of Michigan and Blue Care Network notify the providers by letter 60 days in advance. Submitting claims regularly will prevent disenrollment from taking place.

NJ Medicaid FFS

Effective January 1st 2025, NJ Medicaid will be shifting behavioral health services from FFS(fee for service) to MCOs(managed care organizations). MCOs will be responsible for coordinating care and managing payments, rather than providers billing Medicaid directly. The main 5 MCOs are Aetna, Horizon NJ, United Healthcare Community Plan, Wellpoint and Fidelis. The process to credential providers through the MCOs has begun. You can get more information and credentialing contacts here: https://www.nj.gov/humanservices/dmhas/information/stakeholder/DMAHS_BHI/MCO%20BH%20Contact%20Resource%20Guide%20for%20Providers_7.22.2024.xlsx

My podcast episode with Leaders in Medical Billing

Updated UBH/United/Optum Supervisory billing policy

Updated Claim Submission Requirements for Optum Patients Receiving Supervisory Services Effective Oct. 1, 2024, Optum will reimburse outpatient supervisory services claims covered by Commercial Behavioral Health plans as follows: California, Colorado, Iowa & Massachusetts – Both network and out-of-network providers and groups ALL other states – Only network providers and groups who have an existing, fully executed participation agreement on or before Sept. 30, 2024.

Healthfirst NY online portal retiring

Effective September 30, 2024, member eligibility and benefits verification will retire in Healthfirst’s legacy provider portal (hfproviderportal.org) and should be completed exclusively in Availity Essentials. Eligibility and benefits verification is not the only time-saving tool available to Healthfirst network providers in Availity Essentials: Submit professional and facility claims and gain real-time visibility into the status of a claim. View remittances/explanations of payment with convenient search and filter options. Access additional applications and resources specific to Healthfirst in a dedicated Payer Space, including Member Renewal Roster.

Superior Healthplan copays continue to be waived for outpatient mental health

Effective 10/1/24: Co-pays will Resume for CHIP COVID-19 Services Date: 07/03/24 During the COVID-19 public health emergency, the Texas Health and Human Services Commission (HHSC) waived co-pays for COVID-19 vaccines, testing, and treatment for Children’s Health Insurance Program (CHIP) members. This waiver will end on September 30, 2024. Providers may begin collecting co-pays for COVID-19 vaccines, testing, and treatment rendered to CHIP eligible members for dates of service on or after October 1, 2024. Providers may not charge co-pays for mental health and substance use disorder outpatient office visits. Co-pays have been permanently removed for mental health and substance use disorder outpatient office visits to comply with federal regulations. CHIP co-pays that members must pay are determined based on their income and do not apply to Native Americans, Alaska Natives, CHIP Perinate and CHIP Perinatal newborn members. Providers must adhere to co-pay guidelines outlined in the Superior HealthPlan STAR, CHIP, STAR+PLUS, STAR Health and STAR Kids Provider Manual (PDF), in the Provider Manuals section of Superior’s Training and Manuals webpage. Eligibility and co-pay information may be verified via Superior’s Secure Provider PortalExternal Link.