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Licensed ProfessionalCounselorsIntroduction to Blue Cross and BlueCare NetworkBlue Cross / BCN Provider OutreachDecember 2015 / January 2016
Purpose of meeting Explain the changes affecting licensed professionalcounselors, including billing requirements Show how to become a Blue Cross / BCN provider,including how to sign up for our electronic systemsIMPORTANT:This information does not apply to LPCs who currently practice in asubstance abuse facility or outpatient psychiatric facility (OPC) and whowill continue to do so.This information does apply to LPCs who now practice or want to practicein an individual or group practice setting.2
Introduction to upcomingchanges for LPCs3
What’s changing?What’s new?Starting Jan. 1, 2016, Blue Cross and BCN will accept claimsdirectly from enrolled LPCs and will reimburse LPCs directly. and LPCs enrolled with Blue Cross / BCN will appear in ouronline provider search.Currently, an LPC’s services are reimbursable only whenbilled under another provider (in an office setting) or whenbilled by a substance abuse facility / OPC.4
What’s changing?Who should enroll? Who should enroll as a Blue Cross or BCN provider?If you want to be reimbursed directly for your servicesto Blue Cross / BCN members rather than bill under asupervising provider, you should enroll as a BlueCross or BCN provider.We’ll show you how to enroll in later slides. If you’re seeing our members in an OPC, you do notneed to enroll.5
What’s changing?Please note This change may not apply to some groups. Alwayscheck the member’s benefits.Note: You’ll do that using our web-DENIS system. In later slides, we’llshow you how to sign up for web-DENIS.6
Some importantdifferences betweenBlue Cross and Blue CareNetwork7
Blue Cross / BCNcomparisonQUESTION12What is Blue Cross / BCN?Which provider networks are nowaccepting LPCs?Note: The Medicare Plus BlueSMPreferred Provider Organizationnetwork is not open to LPCs.8Blue Cross / BCNsimilarities and differencesBlue CrossBCN Nonprofit mutualinsurance company Health maintenanceorganization Largest health insurerin Michigan Wholly owned subsidiary ofBlue Cross Blue Shield ofMichigan Traditional BCN HMOSM (commercial) TRUST PPO BCN AdvantageSM Mental Health andSubstance AbuseManaged Care
Blue Cross / BCNcomparisonQUESTION34Blue Cross / BCNsimilarities and differencesBlue CrossBCNStarting Jan. 1, 2016, can LPCservices still be billed under anMD/DO or fully licensedpsychologist?Yes Through Dec. 31, 2015: LPCs can bill undera fully licensed psychologist for services toBCN members.Can LPCs contract asindividual providers?Yes Starting Jan. 1, 2016: LPCs can no longerbill under a supervising provider for servicesto BCN members. Through Jan. 31, 2016: Yes. LPCs canapply to contract with BCN as individualproviders. Starting Feb. 1, 2016: No. LPCs can applyto contract as BCN providers only as part ofan existing group practice. Network needcriteria apply.59Can LPCs still practice in asubstance abuse facility or anOPC setting?YesYes
Provider requirements10
Blue Cross providerrequirementsTitle of state-licensed rendering provider*Blue Cross requirementsby provider typeDirect participationPsychiatristYesFully licensed psychologistYesLimited licensed psychologist‡NoClinical licensed Master’s-level social workerYesNoLicensed professional counselorBilling providerMay be supervised by a fully-licensed psychologistMay be supervised by an MD/DO or fully-licensed psychologistYes, eff. 1/1/16NoMay be supervised by an MD/DO or fully-licensed psychologistLicensed marriage and family therapistNoSupervising MD/DO or fully-licensed psychologistBoard-certified behavior analyst§YesRN with specialty certification as a nurse practitionerYesPhysician assistantNoMay be supervised by an MD/DO or fully-licensed psychologistNoSupervising MD/DO*When professional providers render services in a facility location of service, the facility is the billing provider.‡Thelicense of the profession titled "limited licensed psychologist" is NOT a limited license for the purpose of obtaining postdoctoral training. Alimited licensed psychologist has completed his/her education and practices as Master's-level limited licensed psychologist. A "temporary limitedlicensed psychologist" is completing the post-educational experience to become a limited licensed psychologist.§Not11licensed by the state of Michigan. BCBSM requires certification from the Behavior Analyst Certification Board, Inc.
BCN providerrequirements12What are BCN’srequirements for LPCs?
BCN providerrequirementsWhat are BCN’sprovider requirements? Does the BCN requirements document coversupervision? Yes, but only for billing purposes.For supervision of clinical work with patients, you needto follow the requirements set out by your state-issuedlicense or registration. This includes the minimumnumber of supervision hours, the proximity of thesupervisor to the treating practitioner and the keeping ofnotes / records.Resource:State of Michigan Department of Licensing and Regulatory Affairs (LARA)Bureau of Professional Licensing(517) 373-8068 or BPLHelp@michigan.gov13
BCN providerrequirements1. Go toereferrals.bcbsm.com.2. Click BehavioralHealth.3. Click to open the BCNrequirementsdocument.14Where can I find theBCN requirementsdocument?
Transitioning BCNauthorizationsWhat about currentBCN authorizations? If you are providing services to BCN members under asupervising provider in a solo or group practice, BCN will honorall authorizations for LPC services provided under a fully-licensedpsychologist for the date range of the authorization. If you are submitting a Behavioral Health Continuing OutpatientTreatment Request Form (OTR) for additional sessions within thesame date range of a current authorization and want theauthorization transferred to you rather than go to the supervisingprovider, please make a note of this on the OTR.15oWhen your contract is confirmed, the authorization will be transferred toyou going forward.oIf your contract is not confirmed, the authorization will continue to go tothe supervising provider until the end date of that authorization.
Questions?If you have questions and are already enrolled as a Blue Cross or BCN provider,you can contact your provider consultant.To find out who your provider consultant is, go to bcbsm.com/providers and –1. Click Contact Us.2. Click the link for the Blue Crossor BCN provider contacts.3. Click Provider consultants andthen click the appropriate regional list.16
QUESTIONS?17
How to become aBlue Cross or BCN provider18
Becoming a providerThree steps To become a Blue Cross or BCN provider you must dothree things –1. Enroll2. Be credentialed3. Sign the contract 19We’ll show you how to do that, but
Becoming a providerDefining some terms First, let’s define the terms you’ll need to know –20oIndividual (solo) practitioner: An individual who practicesindependent of a group (does not have a Type II organizationalNational Provider Identifier)oGroup: Bills with a Type II organizational NPI in a professional groupin which there is more than one practitioneroOPC: A facility contracted as a freestanding outpatient psychiatriccare facility by Blue Cross / BCN. These facilities are listed as“outpatient psychiatric centers” in the online Blue Cross / BCNprovider search. You can also contact your facility’s administrator toconfirm.oIncorporated individual practitioner: Bills with a Type II NPI but is theonly practitioner in the group Now, let’s go through the steps for becoming aBlue Cross or BCN provider.
Step 1 - EnrollHow to enrollVisitbcbsm.com/providers.21
Step 1 - EnrollHow to enroll22
Step 1 - EnrollHow to enroll23
Step 1 - EnrollVarious scenariosATo add the LPC to anexisting groupBTo enroll the LPC as asolo practitioner(Type I NPI only)CTo enroll the LPC as anincorporated individual(Type II NPI)24
Step 1 - EnrollScenario ASCENARIO A – To add the LPC to an existing group.Note: Use this form to sign up forProvider Secured Services. That will giveyou access to the web-DENIS system.1225Note: You’ll have to complete a CAQHapplication after you’re done with theenrollment process. It’s part of thecredentialing process. We’ll tell youmore about that later, too.
Step 1 - EnrollScenario ASCENARIO A – To add the LPC to an existing group.3IMPORTANT: On thisform, select whichBlue Crossparticipationagreement(s) youwant. Sign the formand return it.Note: For BCN, thegroup administratoruses the Group ChangeForm (see previousslide) to requestprovider additions andnetwork changes.26Read theapplicableBlue Crossagreementsand filethem forfuturereference.
Step 1 - EnrollScenario BSCENARIO B – To enroll the LPC as a solo practitioner(Type I NPI only)Note: Use this form to sign up forProvider Secured Services /web-DENIS.1CAQHapplication27
Step 1 - EnrollScenario BSCENARIO B – To enroll the LPC as a solo practitioner(Type I NPI only)2328Read the BlueCross agreementsand file them forfuture reference.Select theappropriateagreement(s) onthe combinedsignaturedocument , signthe document andreturn it.Read the BCNagreements and file themfor future reference. Signthe appropriate signaturedocument(s) and returnthem.
Step 1 - EnrollScenario CSCENARIO C – To enroll the LPC as an incorporated individual(Type II NPI)1Note: Use this form to sign up forProvider Secured Services /web-DENIS.CAQHapplication229
Step 1 - EnrollScenario CSCENARIO C – To enroll the LPC as an incorporated individual(Type II NPI)3IMPORTANT: On thisform, select whichBlue Crossparticipationagreement(s) youwant. Sign the formand return it.IMPORTANT: For BlueCross, also sign thisform and return it.For BCN, you’llreceive theagreements via email.30Read theapplicableBlue Crossagreementsand filethem forfuturereference.
Step 2 – BecredentialedCredentialing followsenrollment All enrolled LPCs must be credentialed. The credentialing process starts when you fill out a CAQHapplication, which must be completed within 14 calendardays of the date you submitted your enrollment request. The instructions are at proview.caqh.org/pr There is only one credentialing process for BCBSM andBCN.31
Step 3 – ContractFinal step: The contract Enrolled LPCs will receive countersigned contracts with awelcome letter and an effective date.32
Keeping currentKeep your informationupdated You must update your CAQH information every 120 days. Visitproview.caqh.org/pr. If your demographic information changes, update it with CAQHwithin 30 days of the change. All other changes should be submitted to Blue Cross / BCNProvider Enrollment and Data Management.33
Blue Cross / BCNelectronic systems34
web-DENISWhat is web-DENIS for?You’ll use web-DENISto check a member’seligibility and benefitsat each visit.You signed up forweb-DENIS when youcompleted the NewMental HealthPractitioner EnrollmentForm.35Note: Use this form to sign up forProvider Secured Services /web-DENIS.
Sign up to use BCN’se-referral systemBCN providers use thee-referral system tosubmit requests toauthorize services. Tosign up, go toereferrals.bcbsm.comand click Sign Up orChange a User.Follow the instructionsthere.36How to sign up fore-referral
Guide for using BCN’se-referral systemAt ereferrals.bcbsm.com,click Training Tools.Click to open thee-referral User Guide.Look in the BehavioralHealth section of thatguide to see how tosubmit authorizationrequests and check thestatus of your requests.37How to usee-referral
Provider SecuredServicesBoth web-DENIS andBCN’s e-referralsystem are part ofProvider SecuredServices.Once you have a Provider SecuredServices user ID and password,visit bcbsm.com/providers and login as a provider.38Log in to ProviderSecured Services
Opening thesystemsOn the ProviderSecuredServices Homepage, you canclick to accessweb-DENIS (forboth BCBSMand BCNproviders) andBCN’s e-referralsystem.39
QUESTIONS?40
The license of the profession titled "limited licensed psychologist" is NOT a limited license for the purpose of obtaining postdoctoral training. A limited licensed psychologist has completed his/her education and practices as Master's -level limited licensed psychologist. A "temporary limited
