BlueChoice HealthPlan of South Carolina

Outpatient Mental Health Services and Rehabilitative Behavioral Health Services to be Managed by BlueChoice HealthPlan Medicaid

This information is effective immediately and will be reflected in the next provider manual update.

Summary

Beginning July 1, 2016, BlueChoice HealthPlan Medicaid will begin management of outpatient mental health services and rehabilitative behavioral health services (RBHS) previously administered by the South Carolina Department of Health and Human Services (SCDHHS). 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. This bulletin seeks to clarify that there are no copays for members receiving RBHS.

Frequently Asked Questions

Q: Will providers have to be enrolled and credentialed with BlueChoice HealthPlan Medicaid to provide these services?
A: Yes, all providers of RBHS are required to be enrolled and credentialed with BlueChoice HealthPlan Medicaid.
Q: Do providers still have to be enrolled with SCDHHS if their clients are enrolled with BlueChoice HealthPlan Medicaid?
A: Yes, providers will have to enroll and remain in good standing with SCDHHS prior to contracting with BlueChoice HealthPlan Medicaid.
Q: How do I know if a service requires prior authorization?
A: Once you have contracted and enrolled with BlueChoice HealthPlan Medicaid, you will receive information regarding the appropriate authorization and claim billing procedures.
Q: I have members who are scheduled prior to July 1, 2016. How will this affect their appointment and treatment?
A: The change in management of this benefit does not occur until July 1, 2016, and will have no impact on this appointment.
Q: I have members scheduled on or after July 1, 2016. How will this affect me?
A: 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.

Resources You May Need

Behavioral Health CM Appt Follow up Form

Blue Choice

South Carolina Healthy Connections

Behavioral Health Benefits

Outpatient Mental Health Services and Rehabilitative Behavioral Health Services to be Managed by BlueChoice HealthPlan Medicaid

Summary

What This Means to You

Frequently Asked Questions

Resources You May Need