Blue Choice

South Carolina Healthy Connections

Behavioral Health Benefits

For Rehabilitative Behavioral Health Services (RBHS) Carve-In information, visit https://msp.scdhhs.gov/rbhs/.

This provider bulletin is an update to BlueChoice HealthPlan Medicaid’s Provider Manual. This information is effective immediately and will be reflected in the next Manual update.

Summary:

Beginning July 1, 2016, BlueChoice HealthPlan Medicaid will begin management of Outpatient Mental Health (MH) Services and Rehabilitative Behavioral Health Services (RBHS) previously administered by the South Carolina Department of Health and Human Services (DHHS). Coordinated care benefits include community integration services and therapeutic child care centers.

What this means to you?

There will be some changes to the prior authorization process and claims filing process. For dates of service on or after July 1, 2016, providers will need to verify eligibility and for some services receive prior authorization from BlueChoice HealthPlan Medicaid.

Frequently Asked Questions:

  • Will providers have to be enrolled and credentialed with BlueChoice HealthPlan Medicaid to provide these services?
    • Yes, all providers of RBHS services are required to be enrolled and credentialed with BlueChoice HealthPlan Medicaid.
  • Do providers still have to be enrolled with DHHS if their clients are enrolled with BlueChoice HealthPlan Medicaid?
    • Yes, providers will have to enroll and remain in good standing with DHHS prior to contracting with BlueChoice HealthPlan Medicaid.
  • How do I know if a service requires prior authorization?
    • Once you have contracted and enrolled BlueChoice HealthPlan Medicaid, you will receive information regarding the appropriate authorization and claim billing procedures.
  • I have members that are scheduled prior to July 1, 2016. How will this affect their appointment and treatment?
    • The change in management of this benefit does not occur until July 1, 2016, and will have no impact on this appointment.
  • I have members scheduled on or after July 1, 2016? How will this affect me?
    • Please contact the Customer Care Center, via the number on the back of the member’s insurance card, to verify benefit coverage and obtain prior authorization.

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