Behavioral Health Providers: Frequently Asked questions
- What has changed as far as behavioral health services?
- Will some services still be covered by Medicaid fee-for-service?
- Which providers will be affected by this change?
- What is the turnaround time for authorizations?
- What do I need to submit when trying to obtain authorization for additional/extension of services for behavioral health outpatient treatment?
- What is the reimbursement rate?
- Will authorizations be required for any outpatient services?
- Are services for private residential treatment facilities (PRTF), developmental evaluation centers (DEC) services or adolescent treatment facilities (ATF) covered?
- Are any Departments of Juvenile Justice (DJJ) services covered?
- Are services for a primary diagnosis of autism covered?
- Are mental health or substance abuse services provided by the MUSC Institute of Psychiatry
- If a provider is part of a practice and the practice does not wish to participate with Select Health, can the individual provider still participate?
- Do co-pays apply to these services?
- Where are claims submitted?
- Is a LPC-Intern able to provide services and bill under an LPC-Supervisor?
- Whom do I contact if I am interested in becoming a participating provider?
What has changed as far as behavioral health services?
A1. Effective April 1, 2012, the professional and outpatient facility charges for Licensed Independent Practitioners (LIPS) associated with Medicaid covered behavioral health services became part of the managed care organizations (MCO) covered responsibilities.
A2. Effective Feb. 1, 2013 the services provided by the South Carolina Department of Alcohol and Other Drug Services became part of the MCO covered responsibilities.
A3. Effective July 15, 2014 Select Health of SC (SHSC) will no longer require prior authorization for certain behavioral health outpatient therapy and medication management services for in-network/participating LIPS, psychiatrists, psychologists, and nurse practitioners. This no authorization requirement will be retro-active to January 1, 2014.
A4. Effective July 1, 2016, Rehabilitative Behavioral Health Services (RBHS) became a covered benefit under the Select Health plan. Credentialed RBHS Providers, credentialed TFC providers, DMH, credentialed DOE and DJJ providers, MUSC, and DAODAS providers can provide the following RBHS services: Behavior Modification (members under 18), Psychosocial Rehabilitative Services, Family Support Services (members 0-21), Community Integration Services (members over 18), Therapeutic Childcare (members 6 years and under), and Peer Support Services (PSS can only be provided by DMH and DAODAS for members over 18).
A5. Effective, July 1, 2017, Autism Spectrum Disorder (ASD) services became a covered benefit under the Select Health plan for members under 21 years of age. This benefit includes ASD services rendered by licensed independent practitioners (LIPs) who are approved by SC Department of Health and Human Services (SCDHHS) to provide Evidence Based Treatment (an ABA alternative therapy modality); Board Certified Behavior Analysts and Board Certified Assistant Behavior Analysts.
The following LIPs providers are permitted to render ASD services for Select Heath members once approved and registered with SC Department of Health and Human Services and Select Health:
- Licensed Independent Practitioners (LIPs) – masters or doctoral:
- Licensed Psychologist
- Licensed Psycho-Educational Specialist (LPES)
- Licensed Independent Social Worker-Clinical Practice (LISW-CP)
- Licensed Marriage and Family Therapist (LMFT)
- Licensed Professional Counselor (LPC)
ASD services may also be rendered by school districts that enroll with SCDHHS as ASD group providers.
A6. Effective July 1, 2017, Select Health will provide coverage for services rendered at a Psychiatric Residential Treatment Facility (PRTF) for eligible members. This benefit includes psychiatric care provided to children under age 21. If services are provided immediately before the member reaches age 21, services may continue until the earlier of the date the member no longer requires the services or the date the member reaches age 22.
Members are referred for PRTF services by a Licensed Practitioner of the Healing Arts (LPHA) via the completion of the PRTF treatment request form. The PRTF referral form can be completed by the admitting facility, current treatment provider, or referral source. For questions regarding a member who is receiving PRTF services, please contact Select Health Behavioral Health Utilization Management.
Will some services still be covered by Medicaid fee-for-service?
Yes. Medicaid fee-for-service will still cover all services provided by the state agencies listed below. Medicaid fee-for-service will also cover all services that the below agencies refer for, even if the treating provider is participating with an MCO.
- Developmental evaluation centers (DEC)
- Adolescent treatment facilities (ATF)
Which providers will be affected by this change?
Licensed Independent Practitioners (LIPs):
- Marriage and family therapists
- Professional counselors
- Independent social workers
- Nurse practitioners
- Federally qualified health centers (FQHC)
- Rural health clinics (RHC)
- Acute care hospitals
- Department of Alcohol and Other Drug Abuse Service Authorities
What is the turnaround time for authorizations?
What do I need to submit when trying to obtain authorization for additional/extension of services for behavioral health outpatient treatment?
What is the reimbursement rate?
Will authorizations be required for any outpatient services?
Yes, some outpatient services require authorization:
For PAR MDs: 90870, 90882, 90887, 90889, 96101 and 96118 require prior authorization
For PAR LIPS: 96110 requires prior authorization
For DAODAS providers: check your service code spreadsheet for guidance.
FOR ALL NON-PAR PROVIDERS - prior authorization is required for any and all services.
Contact Select Health Behavioral Health at 1-866-341-8765 for information on authorization requirements.
- For RBHS, all services require prior authorization.
- For ASD, all services require prior authorization.
- For PRTF, revenue codes 0214 and 0153 require prior authorization.
- For PRTF, revenue code 0183 does not require prior authorization.
Are services for private residential treatment facilities (PRTF), developmental evaluation centers (DEC) services or adolescent treatment facilities (ATF) covered?
Services for private residential treatment facilities (PRTF) are covered by Select Health as of 7/1/2017. Services for developmental evaluation centers (DEC) and adolescent treatment facilities (ATF) are not eligible for Select Health or other managed care plans and must be billed to fee-for-service.
Are any Departments of Juvenile Justice (DJJ) services covered?
Are services for a primary diagnosis of autism covered?
Are mental health or substance abuse services provided by the MUSC Institute of Psychiatry?
Department of Mental Health (DMH) services through MUSC IOP will continue to be handled by Medicaid’s fee-for-service program. However, non-DMH services through MUSC are covered by Select Health.
If a provider is part of a practice and the practice does not wish to participate with Select Health, can the individual provider still participate?
Do co-pays apply to these services?
No, there are no co-pays or deductibles for persons receiving behavioral health care.
Where are claims submitted?
Submit claims to:
Select Health of South Carolina
Claims Processing Department
P.O. Box 7120
London, KY 40742