www.crediblebh.com Login : Official Login – CredibleBH
www.crediblebh.com Login : Official Login – CredibleBH
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While Credible makes every effort to ensure the most up-to-date configuration plan to support the OBH program transition, Partners will need to thoroughly review the AR Medicaid documentation regarding billing business rules to ensure configuration accuracy. This document is utilized as a supplemental tool for guiding configuration needs within a Partner’s Credible Domain.
Overview
Effective July 1, 2018 the Rehabilitative Services for Persons with Mental Illness (RSPMI) Program, Licensed Mental Health Practitioner (LMHP) Program, and the Substance Abuse Treatment Services (SATS) Program will cease to exist. The transition of consumers to Outpatient Behavioral Health Services (OBH) Program will begin on July 1, 2017, and is contingent upon the approval of the OBH Program per Agency. Services for RSPMI, LMHP, and SATS programs with Dates of Service after June 30, 2018, will not be paid by Arkansas Medicaid.
Outpatient Behavioral Health Services Billing Rules
• Daily Limit: Maximum of 8 hours per 24 hour day of OBH services.
• Counseling Level Services are rendered in a behavioral health clinic, healthcare center, physician office, and/or school.
• OBH is not TPL exempt.
• Outpatient Services are billed in 15 minute units and billed on a per unit basis: daily total, per consumer, per service.
1 unit = 8-24 minutes
2 units = 25-39 minutes
3 units = 40-49 minutes
4 units = 50-60 minutes
• No ‘carryover’ of time is allowed from one day to another.
Configuration Considerations
• Billing Matrixo For each Service Type (i.e Individual Counseling, Family Counseling, etc.) utilize a unique roll codeto merge service types together for a single consumer per day.
o Configure an Over Production Cap of the maximum allowed units hours per day per service types.The Over Production Cap should be configured on all billable OBH service billing matrix lines.
o Utilize Credential Groups as a matching criteria to address varying rates and modifiers based oncredential level.
o For Billing Matrix lines where the Credential Group supports non-licensed and credentialedemployees, select ‘provider for rendering’ = True to send the Agency’s NPI.
• Licensed/Credentialed staff will need to send the Employee’s NPI as the rendering Provider > BillingGroup: Provider For Rendering = False.