Billing Guidelines for BHT/ABA Services
| Date: | January 08, 2025 |
| From: | Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) |
| To: | Health Plan Behavioral Health Treatment (BHT) / Applied Behavioral Analysis (ABA) Providers |
| Type: | Regulatory |
| Subject: | Billing Guidelines for BHT/ABA Services |
| Business: | Medi-Cal Managed Care |
Through the Claims Editing System (CES), Health Plan has identified a trend in claims not being billed correctly for BHT/ABA services. As a reminder, please follow the billing guidelines below to ensure proper claim submission and reimbursement.
- Add appropriate authorization number to the claim header
An authorization is required for all BHT/ABA services. Include the appropriate authorization number on the claim and ensure it is for the correct member.
- Bill with appropriate HCPCS codes
Only the correct HCPCS codes will be accepted when billing BHT/ABA therapy.
- Bill with modifiers
Modifiers need to be included with the HCPCS code when submitting a claim. Based on your provider type, use the appropriate modifier for the claim.
- Add the rendering provider NPI to the claim
This should be the same provider for the modifier that is being billed for the services rendered.
Health Plan will process claims for payment submitted from 10/1/2024 through 1/31/2025, without requiring an authorization number on the claim. Beginning 2/1/2025, providers must follow the above billing guidelines and include the authorization number on the claim to avoid payment denials.
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website www.hpsj-mvhp.org
