Billing Tools

Paying for Primary Care and Behavioral Health Services Provided in Integrated Care Settings

Interim State-based Billing and Financial Worksheets

CIHS provides tools and resources to primary and behavioral healthcare organizations to help them successfully implement bidirectional integrated healthcare. A key success factor is the financial viability and sustainability of programs’ integration efforts, including appropriate and accurate billing for services. CIHS has developed customized Interim Billing and Financial Worksheets for each state that identify existing billing opportunities for services provided in integrated settings. In states where the identified codes are not currently reimbursable, these worksheets identify areas of potential state policy work. Special thanks to Mary Jean Mork from MaineHealth for her pioneering work in this financing area. The format of these Interim Billing Worksheets was adapted from early work at MaineHealth to identify billing solutions for providers in Maine.

While Medicare billing processes and procedures are consistent nationwide, Medicaid benefits, coding, and payment requirements vary across states, territories, and the District of Columbia. To effectively bill for Medicaid reimbursable services, organizations must submit a claim form that contains specific CPT (Current Procedural Terminology) codes that link to relevant billable diagnostic codes and are provided by appropriately licensed professionals. CPT and diagnostic codes are consistent across the country; however, state Medicaid programs determine the types of services, codes, and individuals credentialed to provide services, resulting in unique billing rules and regulations in each state.

Financing is often perceived as one the three biggest barriers to sustainable integration activities. By not billing at all, or billing incorrectly, providers risk denied or delayed claims payments, wasted time and resources, and missed reimbursement opportunities for services provided. These Interim Billing Worksheets will assist Primary and Behavioral Health Care Integration (PBHCI) grantees and others bill correctly by informing providers on available CPT codes that can be used to bill for services and the discipline and credential required by the public funding source (i.e., Medicare, Medicaid) to bill for the CPT code.   

The services provided as part of bidirectional integration are often more easily billable in partnerships between Federally Qualified Health Centers (FQHCs) and community behavioral health organizations. These Billing and Financial Worksheets identify the core set of CPT codes used to bill for specific bidirectional health and wellness services provided by FQHCs and/or community behavioral health organizations. The Worksheets link CTP codes with the state-specific diagnostic codes and associated professional credentials needed to submit a successful, payable claim. 

Private insurance companies can also use the CPT codes in these Worksheets for billing and reimbursement. However, commercial insurance programs are individualized and more varied than Medicaid. Contact commercial insurance companies directly to determine what services are covered. 

Each of the Interim CIHS Billing and Financial Worksheets have been reviewed by the specific state’s Medicaid office. With continuing changes in healthcare financing, states continually review and update their Medicaid state plans and programs. It is important to understand that these CIHS Worksheets provide a “point in time” and information may change as states change their Medicaid programs. Please communicate changes affecting your state’s billing guidelines to CIHS; CIHS will update these Worksheets regularly.

• Alabama Billing and Financial Worksheet
• Alaska Billing and Financial Worksheet
• Arizona Billing and Financial Worksheet
• Arkansas Billing and Financial Worksheet
• California Billing and Financial Worksheet
• Colorado Billing and Financial Worksheet
• Connecticut Billing and Financial Worksheet
• Delaware Billing and Financial Worksheet
• Florida Billing and Financial Worksheet
• Georgia Billing and Financial Worksheet
• Hawaii Billing and Financial Worksheet
• Idaho Billing and Financial Worksheet
• Illinois Billing and Financial Worksheet
• Indiana Billing and Financial Worksheet
• Iowa Billing and Financial Worksheet
• Kansas Billing and Financial Worksheet
• Kentucky Billing and Financial Worksheet
• Louisiana Billing and Financial Worksheet
• Maine Billing and Financial Worksheet
• Maryland Billing and Financial Worksheet
• Massachusetts Billing and Financial Worksheet
• Michigan Billing and Financial Worksheet
• Minnesota Billing and Financial Worksheet
• Mississippi Billing and Financial Worksheet
• Missouri Billing and Financial Worksheet
• Montana Billing and Financial Worksheet
• Nebraska Billing and Financial Worksheet
• Nevada Billing and Financial Worksheet
• New Hampshire Billing and Financial Worksheet
• New Jersey Billing and Financial Worksheet
• New Mexico Billing and Financial Worksheet
• New York Billing and Financial Worksheet
• North Carolina Billing and Financial Worksheet
• North Dakota Billing and Financial Worksheet
• Ohio Billing and Financial Worksheet
• Oklahoma Billing and Financial Worksheet
• Oregon Billing and Financial Worksheet
• Pennsylvania Billing and Financial Worksheet
• Rhode Island Billing and Financial Worksheet
• South Carolina Billing and Financial Worksheet
• South Dakota Billing and Financial Worksheet
• Tennessee: Contact the State Medicaid Office 
• Texas Billing and Financial Worksheet
• Utah Billing and Financial Worksheet
• Vermont Billing and Financial Worksheet
• Virginia Billing and Financial Worksheet
• Washington Billing and Financial Worksheet
• West Virginia Billing and Financial Worksheet
• Wisconsin Billing and Financial Worksheet
• Wyoming Billing and Financial Worksheet
  

WEBINARS

Billing for Integrated Health Services
June 12, 2012
Presented by Kathleen Reynolds

• Recording

• Presentation

• Transcript