Managed Care Organizations (MCOs) and Behavioral Health

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Effective April 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) will be including the professional and outpatient facility charges associated with Medicaid covered behavioral health services as part of the Managed Care Organization (MCO) covered responsibilities.  Providers will be required to file claims for behavioral health services to the MCOs for MCO enrolled beneficiaries.  Providers must verify eligibility and contact the applicable MCO for prior authorization before rendering services.

 

This change is specific to behavioral health services provided by Licensed Independent Practitioners (LIPs) providers, Federally Qualified Health Clinics (FQHCs), Rural Health Clinics (RHCs), Physicians, and Nurse Practitioners, and services rendered in a general acute care hospital setting.  Providers not already contracted with the MCOs are encouraged to do so.  Below is the contact information for each MCO’s business office.

 

MCO

Phone Number

Absolute Total Care

803-933-3638

BlueChoice HealthPlan

800-327-3183 x 25909

First Choice by Select Health

843-270-6330

UnitedHealthcare CommunityPlan

803-798-6210

 

 

Behavioral health procedure codes to be included as part of the MCO covered responsibilities include: CPT 90804 – 90829, 90846, 90847, 90853, 90862, 90870, 90882, 90887, 90899, 96101, HCPCS H0002, H2000, H2011, and encounter code T1015 with an HE modifier.  For guidance on codes billable for your specific provider type, please refer to your applicable provider manual located on the SCDHHS website – www.scdhhs.gov.

 

As a follow-up, regional trainings are being facilitated to Licensed Independent Professionals (LIPs) to provide an overview of Managed Care.  LIPs providers may register for training through the South Carolina Medicaid Provider Education Website, www.scmedicaidprovider.org, or by calling South Carolina Medicaid Provider Outreach at 1-888-289-0709. 

 

Training dates are listed below:

 

Columbia, SC

Greenville, SC

Monday, March 19, 2012

Wednesday, March 21, 2012

BlueCross BlueShield of SC

Greenville Technical College

17 Technology Circle, Farrow Road

506 South Pleasantburg Drive 29607

Bldg: Palmetto GBA

Bldg: Technical Resource Center Auditorium

10:00 am – 1:00 pm

10:00 am – 1:00 pm

Florence, SC

 

Thursday, March 22, 2012

 

Florence/Darlington Technical College

 

2715 West Lucas Street 29501

 

Bldg: Fred C Fore Auditorium

 

10:00 am – 1:00 pm

 

 

 

Your continued support of the South Carolina Medicaid Program is appreciated.  Please refer any questions or concerns regarding this bulletin to the Managed Care staff at (803) 898-4614. 

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