School Based Mental Health Initiative
In accordance with the South Carolina Department of Health and Human Services (SCDHHS) School-based Mental Health Initiative, effective July 1, 2022:
Rehabilitative Behavioral Health Services (RBHS) are allowed to be delivered in school settings by Select Health of South Carolina master’s level behavioral health providers, who are contracted by the school district. We have summarized the guidelines here; however, providers are advised to review the recently updated SCDHHS Local Education Agencies (LEA) Services Provider Manual , the LEA School-based Services Alternative Fee Schedule (PDF) and Frequently Asked Questions (FAQ) document located on the SCDHHS School-based Mental Health Services webpage for full details.
South Carolina school districts will be free to choose to:
- Continue to utilize the South Carolina Department of Mental Health (DMH) by contracting with DMH, who will then bill Select Health.
- Hire their own counselors and bill Select Health directly.
- Contract with a private provider, who will bill Select Health directly.
- Use a combination of these delivery methods to meet the needs of the children in their district.
Services Eligible in the School-based Setting
- Diagnostic Assessment - Initial and Follow up:
- 90791 – Diagnostic evaluation without medical services – 1 per member every 6 months.
- H0031 – Mental health comprehensive assessment follow-up – 12/year.
- Service Plan Development (H0032) – 15 minutes = 1 unit; 10 units/week.
- Crisis Management (H2011) – 15 minutes = 1 unit; 16 units/day; 80 units/year.
- Individual Psychotherapy:
- 90832 – 30 minutes = 1 unit; 1/day; 6/month.
- 90834 – 45 minutes = 1 unit; 1/day; 6/month.
- 90837 – 60 minutes = 1 unit; 1/day; 6/month.
- Family Psychotherapy:
- 90846 (without patient) – 50 minutes = 1 unit; 1/day; 4/month.
- 90847 (with patient) - 50 minutes = 1 unit; 1/day; 4/month.
- Group Psychotherapy (90853) – 60 minutes = 1 unit; 8/month.
These services will be reimbursed according to the LEA School-based Services Alternative Fee Schedule (PDF).
Eligible Provider Types
The following professionals may be reimbursed for providing RBHS in the school setting:
- Licensed Independent Social Worker
- Licensed Marriage and Family Therapist
- Licensed Professional Counselor
- Licensed Psycho-Educational Specialist
- Licensed Master Social Worker (supervision required)
- Mental Health Professional (supervision required)
- Qualified Clinical Professional (DMH only)
Existing Licensed Independent Practitioners (LIPS) and RBHS providers, school districts, and DMH providers will not need to complete a new application. However, submission of a fully executed agreement with a SC School District to email@example.com is required prior to rendering services.
Unenrolled RBHS providers will need to complete the Healthy Connections Medicaid provider application (located on the SCDHHS website) and a Select Health credentialing application.
- A Training Video for School-based Provider Enrollment process is available on SCDHHS’ website.
- SCDHHS will begin enrolling new RBHS providers for the purpose of delivering RBHS to students in school-based settings on or after July 11, 2022.
- In addition to all standard enrollment information, a copy of the fully executed school district agreement(s) indicating the school(s) in which services will be provided must be submitted to: firstname.lastname@example.org.
To obtain the Select Health credentialing application packet, please contact: Kathy McLaurin at KMcLaurin@selecthealthofsc.com.
For Select Health private practice Licensed Independent Practitioners (LIPs) and RBHS providers, medical necessity review is required for outpatient psychotherapy visits (codes 90832, 90834, 90837) after 24 visits per calendar year. See the IMPORTANT CLARIFICATION: Individual Psychotherapy Medical Necessity Review Update (PDF) provider alert for full details.
Submission of prior authorization requests:
- Submit an authorization request through the NaviNet/JIVA prior authorization provider portal.
- Each provider group must be registered to use NaviNet. If not currently registered, click on the Register for a new account link on the login page and complete the online registration.
- To submit the authorization request follow the step-by-step instructions for submitting prior authorization requests (PDF) available on the Select Health Behavioral Health webpage.
Required documentation to be uploaded with the request:
- The most recent individual plan of care (IPOC)
- Progress note(s)
- Three (3) most recent clinical service notes
- Specify the number of additional visits being requested for each code.
- The remaining benefit limit is 48 visits for the three codes combined.
- An approval notification and certification number will be provided within the provider portal within minutes of submission.
- All of the required documents must be uploaded as one file into the NaviNet/JIVA portal. Failure to do so will result in a denial of the request.
- If a claim is submitted for the 25th visit prior to the submission of the prior authorization request, it will be denied for X01 – authorization or referral not obtained.
- After approval is received, the claim for the 25th visit will need to be submitted, or if a denial was received, the denied claim will need to be resubmitted.
- Limitation: 6 visits/month.
The standard appeal process applies. For full details, see our Health Care Professional and Provider Manual- Appeal of Utilization Management decisions section.
- Member Consent for Provider to File an Appeal form (PDF) may be used, located on the Select Health website.
- Submit appeals and supporting documentation to:
Select Health of South Carolina
Attn: Member Appeals
P.O. Box 40849
Charleston, SC 29423-0849
Billing for Services
- Submit claims utilizing the CMS-1500 claim form.
- Services will require specific modifier(s) to receive reimbursement and must be filed with a place of service of “03.”
- Billing modifiers must match the credentials of the individual rendering the service. Modifiers for school-based mental health services include:
- H1- Licensed Clinician
- Licensed Clinician refers to licensed or certified professionals allowed to practice at the independent level. This includes: LPC, LMFT, LISW, LPES, Certified School Psychologist II, and Certified School Psychologist III.
- H2- Unlicensed Clinician
- Unlicensed Clinician refers to those professionals who require supervision and co-signature on their Diagnostic Assessment (which is used to confirm medical necessity). This includes: LMSW, MHP, and Certified School Psychologist I.
- H1- Licensed Clinician
- The initial and follow-up DAs are billed as an encounter. (90791/H0031).
- Remember the initial assessment (90791) may be rendered once every six months per member and may have been rendered by another provider.
- To avoid a claim denial, providers are advised to contact the Provider Contact Center at 1-800-575-0418 to ask if another provider has billed this code for the member prior to rendering the assessment.
- Each school will be assigned a unique ID that must be included on submitted claims. The list of unique school IDs will be published on the SCDHHS School–based Mental Health Services webpage.
- For all claims: Submit school ID in box 19 (Loop 2300, segment NTE) on the CMS-1500 claim form.
- Approved RBHS providers (on SCDHHS list and credentialed with Select Health): Submit claims under your facility NPI in box 33, with place of service 03.
- Approved LIPS providers (on SCDHHS list and credentialed with Select Health): Submit the rendering provider NPI in box 24J, your group NPI in box 33, and place of service 03.
- School Districts: Submit claims under your facility NPI in box 33, with place of service 03.
- Services may also be rendered via telehealth: Submit claims with the H1/H2 modifier in the first position and the GT modifier in the second position, with place of service 03.
Provider disputes are generally administrative in nature, involving post-service denials or reductions, as well as claims issues. For details of the dispute submission process, see our Health Care Professional and Provider Manual- Health care professional/provider disputes section.
- To register a dispute in writing, a written explanation of the issue and any supporting documentation should be sent to:
Select Health of South Carolina
Provider Claims Disputes
PO Box 7310
London, KY 40742-7310
Providers may also complete the online Provider Claim Dispute form (PDF).
NaviNet Claims Investigation - allows providers to submit claims adjustment inquires for discrepancies on how a claim was processed or to request reconsideration of a claim. A training video is provided in the NaviNet provider portal on the process for submitting inquires.
Claims submission portal
Select Health provides a no-cost claims submission portal for our providers called ConnectCenter™, which is accessed via NaviNet: https://navinet.navimedix.com under Workflows for this Plan: Claims submission link, or via a direct link: https://physician.connectcenter.changehealthcare.com/.
ConnectCenter provides guides to assist with set-up and claims submission within the portal. For information about ConnectCenter, visit: Electronic Claims Submission, Payment, and Remittance Advice Services.
For questions, concerns, or to request one-on-one training, please feel free to contact your Provider Network Management Account Executive.
Select Health has partnered with Change Healthcare and ECHO Health to offer payment options for our providers. Visit the Electronic Claims Submission, Payment, and Remittance Advice Services webpage to learn more.
SCDHHS is preparing several training resources for South Carolina school district staff and behavioral health providers. Several of these resources are already available on the agency’s school-based mental health services webpage. SCDHHS will send additional communications as more resources become available.
Please direct any questions or concerns regarding the policy changes to the SCDHHS Office of Behavioral Health at: email@example.com.