- Bcbstx behavioral health. Post-Service Reviews. Outpatient Management for members who have this component as part of their behavioral health benefit plan through BCBSTX. Ask your provider to go to Prior Authorization Requests to get forms and information on services that may need approval before they prescribe a specific medicine, medical Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association The Behavioral Health Clinical Practice Guidelines are applicable to all BCBSTX Behavioral Health (BH) product lines including Texas Government Programs. Practice Description. It includes management of intensive and some routine outpatient services. Access medical and behavioral professionals for coaching, advice or direct care. Prior authorization must be obtained prior to the delivery of care for behavioral health services. It can help with common challenges like stress, anxiety, depression, insomnia and substance abuse. Utilization management includes: Prior Authorization. Behavioral Health Program Overview. Submit completed Behavioral Health Forms to: Blue Cross and Blue Shield of Texas Behavioral Health Unit PO Box 660241 Dallas, TX 75266-0241 Fax Number: toll-free 877-361-7646 All behavioral health benefits are subject to the terms and conditions as listed in the member’s benefit plan The Behavioral Health program is available only to those members whose health plans include behavioral health benefits through BCBSTX. Interactive. Email: TX_Medicaid_HC@bcbstx. Information about inpatient and outpatient services (counseling, medication, testing and more) Inpatient Wellness and Behavioral Health Insurance Coverage. BCBSTX’s behavioral health care management is integrated with our medical care management program, to help members access their behavioral health benefits and to improve coordination of care between medical and behavioral health providers. O. m. The Behavioral Health program provides BCBSTX members a wide range of services, including: A Behavioral Health Member Services team that can help members find providers and can answer many questions about eligibility, benefits and more. Our experience has been that members who have consistent support throughout all All behavioral health benefits are subject to the terms and conditions as listed in the member’s benefit plan The Behavioral Health program is available only to those members whose health plans include behavioral health benefits through BCBSTX. Behavioral Health is not available on all plans. Here are some important details: Behavioral Health: • Transition Period: BCBSTX will honor all authorizations and referrals on file with Magellan for up to 180 days from the effective date of The Behavioral Health Clinical Practice Guidelines are applicable to all BCBSTX Behavioral Health (BH) product lines including Texas Government Programs. Behavioral Health Customer Service Phone and Fax Numbers and Address, cont. Our experience has been that members who have consistent support throughout all All providers who participate in our networks are required to complete a credentialing process prior to acceptance. Note: Complete this form in its entirety to ensure BCBSTX has accurate information and timely communication with the member if needed. Behavioral health is the scientific study of emotions, behaviors and biology. How Does This Affect Members? We will notify Blue Essentials and Blue Premier members before the transition date. It includes management of intensive and some The Blue Cross and Blue Shield of Texas (BCBSTX) Behavioral Health (BH) Outpatient Management Program includes the management of intensive and some routine outpatient services. These guidelines are designed to assist clinicians by providing a framework for evaluation, and treatment of patients and is not intended to either replace a clinician’s judgment or Behavioral Health Program Components: Inpatient Management for inpatient, partial hospitalization, and residential treatment center (RTC) services. Prior Authorization Managed by BCBSTX: Use Availity Authorization & Referrals tool; Call 1-800-528-7264 or the number listed on the back of the member ID card. It includes management of intensive and some If you need registration assistance, contact Availity Client Services at 1-800-282-4548. Behavioral Health Quality Indicators and behavioral health providers. 800-729-2422: Behavioral health services - claims BCBSTX Behavioral Health Unit PO Box 660241 Dallas, TX 75266-0241 Fax 877-361-7646. It is offered to members 13 and older and caregivers. Contact Information: STAR/CHIP. Submit completed Behavioral Health Forms to: Blue Cross and Blue Shield of Texas Behavioral Health Unit PO Box 660241 Dallas, TX 75266-0241 Fax Number: toll-free 877-361-7646 If you have, or believe you may have, a mental health problem, it is helpful to talk about these issues with others. For providers licensed in New Mexico and the District of Columbia, Urgent Care service is limited to interactive online video; Behavioral Health service requires video for the initial visit but may use video or audio for follow-up visits, based on the provider’s clinical judgment. Ages 13-17. Earn incentives for healthy behaviors. All services must be medically necessary. (CST) Monday through Friday. Submit completed Behavioral Health Forms to: Blue Cross and Blue Shield of Texas Behavioral Health Unit PO Box 660241 Dallas, TX 75266-0241 Fax Number: toll-free 877-361-7646 Get links to current claim forms, understand how to submit claims to BCBSTX, read claim responses and use the Claim Review Form to submit adjustment requests. ” The prior authorization is then completed, and the results are sent to the provider. CMS-1500 Claims Filing Address. 800-729-2422: Behavioral health services - claims Behavioral Health Quality Improvement (BH QI) department continually monitors and evaluates the Behavioral Health Care Management program for BCBSTX. The evidence-based clinical guidelines from nationally recognized sources are designed to provide a framework for BCBSTX contracted Your employees will have access to a nationwide network of more than 430,000 behavioral health professionals and treatment facilities through Provider Finder ®. Learn more. It includes management of intensive and some BCBSTX Behavioral Health Unit PO Box 660241 Dallas, TX 75266-0241 Fax 877-361-7646. Normal Customer Service hours are 8:00 a. It looks at all the pieces of the puzzle that play a role in a person’s physical Fax numbers: 1-877-361-7646 or 1-312-946-3735. Submit completed Behavioral Health Forms to: Blue Cross and Blue Shield of Texas Behavioral Health Unit PO Box 660241 Dallas, TX 75266-0241 Fax Number: toll-free 877-361-7646 Behavioral Health Quality Improvement (BH QI) department continually monitors and evaluates the Behavioral Health Care Management program for BCBSTX. The following forms are available on the BCBSTX provider website under Education and Reference, Forms and then go to the Behavioral Health section or by calling 1-800-528-7264. These guidelines are designed to assist clinicians by providing a framework for evaluation, and treatment of patients and is not intended to either replace a clinician’s judgment or Behavioral Health Program Components: Care/Utilization Management: Inpatient Management for inpatient, partial hospitalization, and residential treatment center (RTC) services. Plus, access to 24/7 therapy coaches for members. Chapter 6 CLAIMS AND BILLING. Administration of Behavioral Health Programs. What Is Behavioral Health? Some people use “mental health” and “behavioral health” interchangeably. BCBSTX Behavioral Health Unit PO Box 660241 Dallas, TX 75266-0241 Fax 877-361-7646. Note: There are separate specific forms for Employee Retirement System of Texas (ERS) or Teacher Retirement System of Texas (TRS) members. Follow-up for Routine Care: Within 1-3 months. Phone: 1-877-214-5630. Medicare Advantage and Texas Medicaid. bcbstx. Online Behavioral Health Program. Urgent: Within 48 hours. The following plans are administered by BCBSTX Behavioral Health Care Management: Blue Choice PPO SM; Blue Blue Cross and Blue Shield of Texas adopts Clinical Practice Guidelines as the foundation for our Behavioral Health Care Management Program. Hemophilia Referral Fax. The BCBSTX Behavioral Health (BH) Team utilizes nationally recognized, evidence based and/or state or federally mandated clinical review criteria for all of its behavioral health clinical decisions. Non-life threatening emergency: Within six (6) hours. This program will help our clinical staff identify members who could Behavioral Health Program Changes for Some Provider Networks. 1-800-729-2422: Behavioral health services The following forms are available on the BCBSTX provider website under Education and Reference, Forms and then go to the Behavioral Health section or by calling 1-800-528-7264. Use information, tools and programs to help them change behavior. Updated 01-16-2024. Behavioral Health Quality Indicators Prior Authorization Managed by BCBSTX: Use Availity Authorization & Referrals tool; Call 1-800-528-7264 or the number listed on the back of the member ID card. Dependent Student Medical Leave Certification Form. APPENDIX A. STAR and CHIP Service Coordination phone number: 1-877-214-5630 (TTY 711) STAR Kids Service Coordination phone number: 1-877-301-4394 (TTY 711) If your provider needs to contact us, he or she may call the Provider Service The Behavioral Health Program also allows the Behavioral Health team to “touch” every member who uses behavioral health care services via our state-of-the-art analytics to identify those who could potentially benefit from our array of programs and services. It includes management of intensive and some Prior Authorization Managed by BCBSTX: Use Availity Authorization & Referrals tool; Call 1-800-528-7264 or the number listed on the back of the member ID card. BCBSTX Behavioral Health Unit P. Ages 6-12. Interactive Questionnaire. Get access to big discounts on health and wellness products. 24/7 Mental Health Line: If you or your covered dependent are in a crisis situation and need immediate help to find resources for care, call (800) 252-8039 (TTY:711). Contact Magellan Health Services or call 1-800-788-4005. To obtain prior authorization, call: BCBSTX 1-800-528-7264 Refer to the online Blue Choice PPO Provider Manual (Section I) for more detailed information. Behavioral health professionals, physicians or member's family member may request prior authorization on behalf of the member. Submit completed Behavioral Health Forms to: Blue Cross and Blue Shield of Texas Behavioral Health Unit PO Box 660241 Dallas, TX 75266-0241 Fax Number: toll-free 877-361-7646 If you are in crisis, call the National Suicide Prevention Lifeline at 988 or 1-800-273-8255. Our experience has been that members who have consistent support throughout all • Medical and Behavioral Health claim processing We want to assure you that BCBSTX is committed to ensuring a smooth transition during this period. 26, 2024. The member’s plan may require prior authorization for certain Behavioral Health (BH) services. We would like to show you a description here but the site won’t allow us. Learn to Live gives self-paced mental health solutions. If you have questions regarding the response, contact BCBSTX Medical Management or the authorizing vendor. Behavioral Health Quality Improvement (BH QI) department continually monitors and evaluates the Behavioral Health Care Management program for BCBSTX. Some members may not have outpatient behavioral health management. We review and adopt updates to guidelines at least every two years. It includes management of intensive and some Behavioral Health providers have contractually agreed to offer appointments to our members according to the following appointment access standards: Initial/Routine Care: Within 10 working days. Hospital Coverage Letter. BCBSTX will comply with all federal and state confidentiality regulations before releasing any information about the member. Refer to Medical Necessity Criteria - Behavioral Health for information utilized by BCBSTX for its group, retail and government products. central time. Get access to big discounts on health and wellness products; Earn incentives for healthy behaviors; Receive additional support and benefits if they are at-risk; Each of these helps drive healthier outcomes and in turn, control costs for members and groups like yours. Behavioral Health Medical Necessity Criteria & Prior Authorizations. These guidelines are designed to assist clinicians by providing a framework for evaluation, and treatment of patients and is not intended to either replace a clinician’s judgment or BCBSTX Behavioral Health Unit PO Box 660240 Dallas, TX 75266-0240 Fax 877-361-7646. Behavioral health claims must be submitted to BCBSTX for reimbursement. to 6:00 p. If you have behavioral health problems, call our Customer Advocate Department at 1-888-657-6061 (TTY: 711). Prior authorizations are a pre-service medical necessity review. The BCBSTX Behavioral Health team uses nationally recognized, evidence-based and/or state or federally mandated clinical review criteria and issue prior authorizations for all behavioral health clinical decisions. The rate increase will be implemented for the services of the below BH mid-level providers , aligning them with 100% of the Medicare fee schedule, by BCBSTX for all inpatient, partial hospitalization and outpatient behavioral health services. The following plans are administered by BCBSTX Behavioral Health Care Management: Blue PremierSM and Blue An Area of Expertise in Eating Disorders designation is available only to Providers who answer "Yes" to all 4 questions above. The rate increase will be implemented for the services of the below BH mid-level providers , aligning them with 100% of the Medicare fee schedule, by A utilization management review determines whether a benefit is covered under the health plan using evidence-based clinical standards of care. Predeterminations. For these members to receive in-network benefits, you must be in our Blue Essentials or Blue Premier provider networks. Monday – Friday from 8:00 a. BH QI identifies program enhancement opportunities benefiting members, physicians and other health care providers and shares information that can be used to achieve the best possible health outcomes. Blue Cross and Blue Shield of Texas (BCBSTX) offers a suite of wellbeing programs, benefits, and resources that connects the physical and mental health of employees to drive healthier outcomes and in turn, control costs for members and groups like yours. Submit completed Behavioral Health Forms to: Blue Cross and Blue Shield of Texas Behavioral Health Unit PO Box 660241 Dallas, TX 75266-0241 Fax Number: toll-free 877-361-7646 Find contacts you need at BCBSTX. Behavioral Health Program Components: Care/Utilization Management: Inpatient Management for inpatient, partial hospitalization, and residential treatment center (RTC) services. Fax: 1-866-644-5456. HealthSelect of Texas and Consumer Directed HealthSelect plans use the Blue Essentials provider network. The Behavioral Health program provides BCBSTX members a wide range of services, including: • A Behavioral Health Member Services team that can help members find providers and can answer many questions about eligibility, benefits and more • 24-hour access to a single point of contact for members and providers Submit behavioral health claims to BCBSTX for reimbursement. For prior authorization, benefits, eligibility, or claims status or questions contact Magellan at 1-800-327-7390. Claim Submission Forms. Refer to the following for additional information: Note: The requirements of creating and/or updating your CAQH profile is important. to 5:00 p. Claims submission address: Blue Cross and Blue Shield of Texas P O Box 660044 Dallas, TX 75266-0044. Members can call the Behavioral Health number listed on their ID card for prior authorization, questions or for urgent behavioral health issues 24/7. What is Prior Authorization. Hospital Coverage Letter — Professional providers should refer to the TX Provider Specialties/Provider Types — Hospital Privileges Requirements List to identify which category below applies to you: Blue Cross and Blue Shield of Texas (BCBSTX) administers behavioral health services (mental health and substance use disorder) for members who have behavioral health benefits through a variety of retail, government and group products. Failure to finalize your CAQH application within 45 days will cause the BCBSTX credentialing Behavioral Health Program Components: Inpatient Management for inpatient, partial hospitalization, and residential treatment center (RTC) services. Starting June 1, 2020, Blue Cross and Blue Shield of Texas (BCBSTX) will administer behavioral health benefits for members enrolled in our Blue Essentials SM, Blue Essentials Access SM, Blue Premier SM and Blue Premier Access SM in place of the current behavioral health administrator, Magellan Healthcare®. Share the following guidelines with your staff and, if applicable, with your billing service agent and electronic data processing service agent. Claim Review Form. Behavioral Health Form — Required to be submitted to BCBSTX for all Behavioral Health Providers. For more information, refer to the Behavioral Health Changes Some medical services and medications may need a prior authorization (PA), sometimes called a “pre-authorization,” before care or medication can be covered as a benefit. For its group and retail membership, BCBSTX licensed behavioral health clinicians utilize the MCG care guidelines for mental health conditions. com. Behavioral Health Program Changes for Some Provider Networks. For most services, you need to get a referral before you can get medical care from anyone except your PCP. These guidelines are designed to assist clinicians by providing a framework for evaluation, and treatment of patients and is not intended to either replace a clinician’s judgment or Magellan Behavior Health Services coordinates all behavioral health (mental health and chemical dependency) services for Medicaid (STAR) and CHIP members. Providers can request prior authorization online Behavioral Health Program Components: Care/Utilization Management: Inpatient Management for inpatient, partial hospitalization, and residential treatment center (RTC) services. Online Questionnaire. The Behavioral Health Program also allows the Behavioral Health team to “touch” every member who uses behavioral health care services via our state-of-the-art analytics to identify those who could potentially benefit from our array of programs and services. Behavioral Health Quality Indicators The Behavioral Health Clinical Practice Guidelines are applicable to all BCBSTX Behavioral Health (BH) product lines including Texas Government Programs. There is a difference, though. We need your help to achieve BCBSTX’s goal of accurate and efficient claims payment. Note: If you do not have Availity access, you may continue to submit your requests using the Professional Fee Schedule Request forms located on our provider website. Coordination of Benefits. Prior Authorization Requirements. Behavioral Health - Areas of Expertise. Ages 18-64. Blue Choice PPO and Blue High Performance Network (BlueHPN) Provider Manual - Behavioral Health Services. Also refer to the Provider Tools page on the provider website for convenient tools available. www. Blue Cross and Blue Shield of Texas (BCBSTX) administers behavioral health services (mental health and substance use disorder) for members who have behavioral health benefits through a variety of retail, government and group products. All admissions to a skilled nursing facility, a long term acute care hospital (LTACH) or a rehabilitation facility. INTRODUCTION AND GENERAL CLAIMS GUIDELINES. To receive in-network benefits, the behavioral health provider must be contracted with the member’s Blue Essentials or Blue Premier provider networks. A referral is a written order from your primary care provider (PCP) for you to see a specialist. In most cases, a referral is good for 12 months. Receive additional support and benefits if they are at-risk. Submit completed Behavioral Health Forms to: Blue Cross and Blue Shield of Texas Behavioral Health Unit PO Box 660241 Dallas, TX 75266-0241 Fax Number: toll-free 877-361-7646 . For questions or concerns related to service coordination feel free to contact our service delivery team. Jan 1, 2024 · Behavioral Health Medical Necessity Criteria & Prior Authorizations. The benefit of the full Program BH Program — inpatient and outpatient management — is that it allows the BH team to assist members throughout the entire continuum of Online Behavioral Health Program. CMS-1500 User Guide & Tutorial. Welcome; Employers; Producers; Providers; Company Information I have a question about Magellan Behavioral Health services: 1-800 All unplanned inpatient hospital care (surgical, non-surgical, behavioral health and/or substance abuse). 800-729-2422: Behavioral health services - claims Use this form to provide needed information for a Blue Cross and Blue Shield of Texas (BCBSTX) member recently discharged from Behavioral Health treatment. For prior authorization and referrals managed by Magellan: Magellan Behavioral Health Providers of Texas, Inc. BCBSTX’s Behavioral Health Care Management (UM) services are accessible 24 hours a day, seven days a week, 365 days a year at 1-800-528-7264 or the number listed on the back of the member‘s ID card. Notification must be made within one business day of admission to the facility. Oct 11, 2023 · Blue Cross Blue Shield of Texas (BCBSTX) is pleased to announce a significant development concerning reimbursement rates for Behavioral Health (BH) mid-level providers; effective January 1, 2024. INSTRUCTIONS — Step 1: save the form to your desktop. is covered by the health plan, and; meets the health plan’s definition of “medically necessary. Learn to Live is a no cost online health program. Plus, access to 24/7 therapy coaches for Oct 24, 2022 · It’s all wrapped up in behavioral health. It includes management of intensive and some Behavioral Health Quality Improvement (BH QI) department continually monitors and evaluates the Behavioral Health Care Management program for BCBSTX. Member Utilization Management Hours and Contact Information. Box 660240 Dallas, TX 75266-0240. See our Wellness & Behavioral Health section for a short description of each Behavioral Health Program Components: Care/Utilization Management: Inpatient Management for inpatient, partial hospitalization, and residential treatment center (RTC) services. The Behavioral Health Clinical Practice Guidelines are applicable to all BCBSTX Behavioral Health (BH) product lines including Texas Government Programs. Corrected Claim Form. Last Updated: Jan. Ages 0-5. Submit completed Behavioral Health Forms to: Blue Cross and Blue Shield of Texas Behavioral Health Unit PO Box 660241 Dallas, TX 75266-0241 Fax Number: toll-free 877-361-7646 Wellness and Behavioral Health Insurance Coverage. In addition, providers can refer members for other services like disease management. If you don't get a referral before you get services, you will get out-of-network benefits. Find an in-network behavioral health professional near you in Texas And the help you need to improve your mental health and overall well being. These guidelines are designed to assist clinicians by providing a framework for evaluation, and treatment of patients and is not intended to either replace a clinician’s judgment or Prior Authorization Managed by BCBSTX: Use Availity Authorization & Referrals tool; Call 1-800-528-7264 or the number listed on the back of the member ID card. Submit completed Behavioral Health Forms to: Blue Cross and Blue Shield of Texas Behavioral Health Unit PO Box 660241 Dallas, TX 75266-0241 Fax Number: toll-free 877-361-7646 Behavioral Health Program Components: Care/Utilization Management: Inpatient Management for inpatient, partial hospitalization, and residential treatment center (RTC) services. All residential treatment program admissions. Identifying the issue and following up with a mental health provider can help you realize you are not alone and that there are steps you can take to feel better. Ask to speak to a mental health clinician, or follow the prompts to get help with a mental health or substance use issue 24 hours a day, seven days a week. qm ss qq fd ci tt vc ed sd ku