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I/T/U SOONERCARE 101 LEARNING OBJECTIVES BH Rules Eligible BH - - PowerPoint PPT Presentation
I/T/U SOONERCARE 101 LEARNING OBJECTIVES BH Rules Eligible BH - - PowerPoint PPT Presentation
I/T/U SOONERCARE 101 LEARNING OBJECTIVES BH Rules Eligible BH Services Billing Issues EVER HAVE THIS FEELING? STAYING IN BOUNDS BEHAVIORAL HEALTH RULES Chapter 30 Medical providers FFS Subchapter 5 Individual
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EVER HAVE THIS FEELING?
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STAYING IN BOUNDS
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BEHAVIORAL HEALTH RULES
Chapter 30 – Medical providers FFS
Subchapter 5 – Individual Providers & Specialties
Part 21 - Outpatient Behavioral Health Services Part 25 – Psychologists Part 26 - Licensed Behavioral Health Services Part 110 – Indian Health Services, Tribal Programs, and
Urban Indian Clinics (I/T/US)
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BEHAVIORAL HEALTH SERVICES
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BEHAVIORAL HEALTH SERVICES
“means professional medical services for the
treatment of a mental health and/or addiction disorder(s).”
- 317:30-5-1087.2 Terms and definitions
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BEHAVIORAL HEALTH SERVICES
(1) Mental Health Assessment/Evaluation Testing; (2) Alcohol and/or Substance Abuse Services
Assessment and Treatment Plan Development;
(3)Crisis Intervention Services; (4) Medication Training and Support; (5) Individual/interactive Psychotherapy; (6) Group Psychotherapy; and (7) Family Psychotherapy.
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ANYONE ELSE EVER FEEL LIKE THIS?
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BEHAVIORAL HEALTH SERVICES
Behavioral health professional therapy services
are covered when provided in accordance with a documented individualized treatment plan, developed to treat the identified mental health and/or substance abuse disorder(s). A minimum of a 45 to 50 minute standard clinical session must be completed by an I/T/U in order to bill an encounter for the session.
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317:30-5-1091.8 DEFINITION OF I/T/U SERVICES
(d) I/T/U outpatient encounters include but are
not limited to:
(8) Behavioral health professional services and
services and supplies incidental to the services of LBHPs; and
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BEHAVIORAL HEALTH RULES
Licensed Behavioral Health Providers (LBHP’s)
Allopathic or Osteopathic Physicians with a current
license and board certification in psychiatry or a current resident
Practitioners with license to practice:
(A) Psychologist, (B) Social Worker (clinical specialty only), (C) Professional Counselor, (D) Marriage and Family Therapist, (E) Behavioral Practitioner, or (F) Alcohol and Drug Counselor.
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BEHAVIORAL HEALTH RULES
A.P.N. – certification in psych. mental health P.A. with specialized mental health training Practitioners who have completed education
requirements to begin an internship or a post- doctoral fellowship in an accredited clinical academic training program *
L.B.H.P. candidates*
*with special requirements
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WHAT REQUIRES A SIGNATURE?
Assessments and progress notes must be
signed by the practitioner providing the service.
Service plans must be signed by the member (if
- ver age 14), by the parent or guardian if under
18, and by the primary LBHP.
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HOW DO I GET HERE?
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THIS IS HOW!
Behavioral Health Revenue Code : 513 OHCA Provider Letter 2006-08 Billing should be done under this revenue code,
not procedure codes.
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