A former co worker set up the Payers module when our clinic first started using Procentive and I believe she set up the PMAPS with HN. The MHCP provider manual says to use HN modifier so we assume all of the PMAPS would fall under that however we have not looked into it much to be honest, until recently. Our BCBS PMAP is set up with U7 however, so I hope that is correct.
We use HN modifier on all PMAP payers for clinical trainees...., but recently started experiencing issues with a MA/Blue plus client. Have you always used U7 for Blue plus and do you have any problems with this?
As far as I know we've always been set up with U7 for BCBS PMAP (since having Procentive which our clinic has had since summer 2013 or maybe 2012. We don't have any issues with U7, at least not yet...
I would suggest contacting each payer for we were instructed to use U7 and did so for Cigna, Health Partners and PreferredOne. After about 6 months and claim issues they changed course and had us stop using the U7 modifier. Health Partners came straight out and stated they won't except billing from trainees per their policy for CD Tx (only Rule 29 clinics for MH services).
Email response from HP:
Thank you for your patience as I researched the U7 modifier. As you recall, you asked me about using the U7 modifier when services are provided by an ADC-T practitioner on 09/08/15.On 09/10/15 I responded by affirming that you should use the modifier for services provided by this practitioner type. Upon further review, I was wrong about the modifier. The description for modifier U7 is “Medicaid level or care as defined by the State”. My understanding is that the State needs to determine when it is appropriate to use U7 with specific codes. Currently, DHS has not defined U7 as a supervision modifier to use in conjunction with code H2035. If Club Recovery wants U7 to be defined as a supervision modifier for code H2035, then it would need to be brought to the AUC or DHS. I apologize for providing incorrect information to you earlier.
I also just want to remind you of HealthPartners’ supervision policy. Per the policy, HealthPartners does not allow non-licensed clinic trainees to treat our commercial members (see attached). I understand that Club Recovery submits claims like a facility, but it is our expectation that commercial members are treated by licensed and credentialed practitioners (i.e. LADCs).
We tasked them on that position citing MN statute and continue to defiantly bill HP when services are provided by an ADC-T. HP's policy:
According to HP’s contract, Section 2.4, "PROVIDER, will be, and will require all Physicians and Allied Health Professionals to remain during the term of the agreement, licensed, registered, certified, accredited or otherwise duly authorized to practice and/or provide services in the state or states in which the PROVIDER practices or provides services."However, according to Minnesota Statute (148F.035 TEMPORARY PERMIT and Minnesota Rules Chapter 4747), an ADC-T has the same and full privileges to practice as a LADC. The only difference is that the ADC-T MUST practice under the scope of a supervising clinician. And the BBHT states:
LADC and Temporary Permit
Licensed Alcohol and Drug Counselors (LADCs) observe, describe, evaluate, interpret, and modify human behavior as it relates to the harmful or pathological use or abuse of alcohol or other drugs. Work settings can include private treatment facilities (inpatient and outpatient), detox facilities, half-way houses, correctional facilities, schools, hospitals, and government facilities.
The Minnesota Department of Health began licensing alcohol and drug counselors (LADCs) in 1998. On July 1, 2005, regulation of the license was transferred to the Board of Behavioral Health and Therapy (BBHT).
Only for Professional Billing do we bill differently (submit claim under the supervising clinician's name) and those claims often involve mental health codes exclusively
.
So as you can see there is no one acceptable answer or consensus amongst the payers. When billing for CD services (H2035 HQ, H2035, H2036 and H0015) we just attach the supervisor to the claim.
Вопросы
We use the U7 modifier for all BCBS and Preferred One claims and the HN modifier for MA and UCare. Do you use the HN modifier for HP PMAP claims also?
A former co worker set up the Payers module when our clinic first started using Procentive and I believe she set up the PMAPS with HN. The MHCP provider manual says to use HN modifier so we assume all of the PMAPS would fall under that however we have not looked into it much to be honest, until recently. Our BCBS PMAP is set up with U7 however, so I hope that is correct.
Do you bill with the supervisor attached to the bill as well?
Yes, supervisor name and NPI.
Yes, name and NPI of supervisor.
I'm revisiting this: what modifier do you use for Health Partners PMAP claims for billing clinical trainees under supervision?
We use HN modifier on all PMAP payers for clinical trainees...., but recently started experiencing issues with a MA/Blue plus client. Have you always used U7 for Blue plus and do you have any problems with this?
As far as I know we've always been set up with U7 for BCBS PMAP (since having Procentive which our clinic has had since summer 2013 or maybe 2012. We don't have any issues with U7, at least not yet...
I would suggest contacting each payer for we were instructed to use U7 and did so for Cigna, Health Partners and PreferredOne. After about 6 months and claim issues they changed course and had us stop using the U7 modifier. Health Partners came straight out and stated they won't except billing from trainees per their policy for CD Tx (only Rule 29 clinics for MH services).
Email response from HP:
Thank you for your patience as I researched the U7 modifier. As you recall, you asked me about using the U7 modifier when services are provided by an ADC-T practitioner on 09/08/15.On 09/10/15 I responded by affirming that you should use the modifier for services provided by this practitioner type. Upon further review, I was wrong about the modifier. The description for modifier U7 is “Medicaid level or care as defined by the State”. My understanding is that the State needs to determine when it is appropriate to use U7 with specific codes. Currently, DHS has not defined U7 as a supervision modifier to use in conjunction with code H2035. If Club Recovery wants U7 to be defined as a supervision modifier for code H2035, then it would need to be brought to the AUC or DHS. I apologize for providing incorrect information to you earlier.
I also just want to remind you of HealthPartners’ supervision policy. Per the policy, HealthPartners does not allow non-licensed clinic trainees to treat our commercial members (see attached). I understand that Club Recovery submits claims like a facility, but it is our expectation that commercial members are treated by licensed and credentialed practitioners (i.e. LADCs).
We tasked them on that position citing MN statute and continue to defiantly bill HP when services are provided by an ADC-T. HP's policy:
According to HP’s contract, Section 2.4, "PROVIDER, will be, and will require all Physicians and Allied Health Professionals to remain during the term of the agreement, licensed, registered, certified, accredited or otherwise duly authorized to practice and/or provide services in the state or states in which the PROVIDER practices or provides services."However, according to Minnesota Statute (148F.035 TEMPORARY PERMIT and Minnesota Rules Chapter 4747), an ADC-T has the same and full privileges to practice as a LADC. The only difference is that the ADC-T MUST practice under the scope of a supervising clinician. And the BBHT states:
LADC and Temporary Permit
Licensed Alcohol and Drug Counselors (LADCs) observe, describe, evaluate, interpret, and modify human behavior as it relates to the harmful or pathological use or abuse of alcohol or other drugs. Work settings can include private treatment facilities (inpatient and outpatient), detox facilities, half-way houses, correctional facilities, schools, hospitals, and government facilities.
The Minnesota Department of Health began licensing alcohol and drug counselors (LADCs) in 1998. On July 1, 2005, regulation of the license was transferred to the Board of Behavioral Health and Therapy (BBHT).
Only for Professional Billing do we bill differently (submit claim under the supervising clinician's name) and those claims often involve mental health codes exclusively
.
So as you can see there is no one acceptable answer or consensus amongst the payers. When billing for CD services (H2035 HQ, H2035, H2036 and H0015) we just attach the supervisor to the claim.
That’s what I can add to this conversation.