BCBS MI discontinues incident to billing for mental health providers in private practice

Effective March 1, 2027, BCBSM will restrict incident-to billing to facility-based settings only, including psychiatric hospitals, community mental health agencies, and similar institutional environments.2 Private practice offices, regardless of size, will no longer qualify. To help providers adjust, a transition period runs from September 1, 2026, through February 28, 2027. During this window, services rendered by limited license clinicians under supervision can still be billed with the "SA" modifier, but reimbursement will be paid at the submitting provider's applicable rate and they will not be eligible for value-based incentive programs.3 After the transition, any limited licensee attempting to bill incident-to from a private practice will face a penalty: only 80% of the allowed amount will be paid, and the claim remains ineligible for value-based reimbursement. https://www.counselingpsychology.org/articles/bcbsm-billing-change-mental-health-2026-06-14/

Quest Behavioral Healthcare closure

By now you should have heard that Quest Behavioral Health will be closing their business June 30th and will no longer be the behavioral health vendor for UPENN and UPHS. Lyra Health will become the behavioral health vendor for UPHS and IBX (Independence BCBS) will become the behavioral health vendor for UPENN. If you want to continue seeing your current Quest clients as IN network providers you will need to become credentialed with Lyra Health and/or Independence BCBS (IBX). Contact info@ttmedbill.com if you'd like credentialing assistance.

NYCE PPO Bridge Program Network

Effective Jan 1, 2026 NYC employees, pre-Medicare eligibile retirees and their dependents will be offered the New York City Employees PPO plan (NYCE PPO), a health benefit plan delivered through a partnership between EmblemHealth and United Healthcare. The NYCE PPO Bridge Program will offer IN network coverage focused on providers within the 13 lower New York State counties of Bronx, Dutchess, Kings, Nassau, New York, Orange, Putnam, Queesn, Richmond, Rockland, Suffolk, Ulster and Westchester. Historically, all behavioral health services were managed and paid through the Carelon network. The NYCE PPO Bridge Program network replaces Carelon effective Jan 1. 2026. Members with Emblem GHI PPO will receive new insurance cards and providers should request those new cards before scheduling appointments. You can find more information on this new program at: https://www.emblemhealth.com/providers/resources/nyce-ppo/faqs

Medicare IN PERSON behavioral health session visit requirement

Beginning January 1, 2026, Medicare will require a mental health therapy session be conducted IN PERSON within six months of an initial session and then at least one session annually thereafter. This requirement was originally scheduled to begin 10/1/2025 but congress agreed to extend until January 2026.

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.