Carelon EAP

Effective December 2, 2024 Carelon will discontinue the Case Activity Form (CAF) for submitting EAP services provided to Carelon members. Provider's will now be able to submit EAP claims via CMS 1500 forms. The CPT code to use is 99404 and the modifier to use is HJ.

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.