January 19, 2010        

BC-10-2

SA-10-1

Cindy Garrison, Education/Communication Coordinator
Institutional Relations
Blue Cross and Blue Shield of Kansas, Inc.
An Independent Licensee of the Blue Cross and Blue Shield Association

Mental Health Parity

What is Mental Health Parity (MHP) you ask?  MHP is the passage of the federal and state legislature that resulted in revisions of the benefits that cover expenses for mental illness and substance use disorders.  This change was effective July 1, 2009 except for the State of Kansas (SOK), Federal Employee Program (FEP), and Administrative Service Only groups (ASO).  For ASO's MHP began with November 1, 2009 renewals and for SOK and FEP, MHP is effective January 1, 2010.  Unions with collective bargaining agreements (CBA) prior to October 2008 may postpone implementation until the CBA expires.  Plumbers and Pipefitters will not implement MHP until 2013.  Upon these implementation effective dates, mental health and substance use benefits are subject to the same payment provisions as health benefits.  This is why it is so important for you to verify coverage and benefits prior to providing services.

Inpatient and partial hospital care continues to require prior authorization.  Due to the nature of intensive outpatient services, we are strongly encouraging providers to prior authorization these services. 

In addition, there will be some instances when medical necessity reviews are required for outpatient services.  When this occurs, the New Directions' staff will notify providers.  The exception to this rule is the Federal Employee Program.  For FEP, all mental health services except psychological testing and pharmacological management require prior authorization.

Providers should call New Directions at 1-800-952-5906 to prior authorize services.

Outpatient

• FEP requires prior authorization.  All other BCBSKS member's require prior authorization after the 8th visit.  Call New Directions for prior approval.
• Bill using revenue code 0900-0904, 0910-0911, 0914-0919 and use appropriate CPT or HCPCS code(s).  FEP: bill using 0914, 0915, or 0916 and the appropriate CPT from 908XX range.
• Services will apply towards the patient's outpatient benefits.

Outpatient Partial Day

• Must be an approved partial day program by BCBSKS.*
• Prior authorization is required.  Call New Directions for prior approval.
• Bill using revenue code 0912 and CPT code 90899 and/or HCPCS code S0201.
• Services will apply toward the patient's outpatient benefits.  BCBSKS will no longer give the patient the option of having benefits apply toward inpatient benefits.

*Submit your program information to your provider consultant for approval.

Intensive Outpatient (IOP)

• Starting January 1, 2010, hospitals must have an approved IOP program by BCBSKS*
• Prior authorization recommended.  Call New Directions for prior approval.
• Bill using revenue codes 0905 and 0906 and HCPCS code S9480
• Services will apply towards the patient's outpatient benefits.

*Submit your program information to your provider consultant for approval.

Inpatient

• Prior authorization required.  Call New Directions for prior approval

CG