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The Mental Health Parity and Addiction Equity Act of 2008 (Act) prohibits large group health plans that provide mental health or substance abuse disorder benefits from establishing more restrictive financial requirements or treatment limitations for mental health or substance abuse disorder services than those established for medical and surgical benefits.
Effective January 1, 2010, for certain patients, prior authorization will be required for all nervous and mental or substance abuse care before any services are to be rendered. Claims cannot be processed without the prior authorization process being completed. If prior authorization is not received and services are denied for medical necessity documentation not received, you will not be able to balance bill the patient.
The prior authorization requirement does not apply to initial consulting or assessment visits. Please see below for a list of codes not requiring prior authorization:
|Service Description||CPT Code|
|Initial Visit||90801, 90802|
|Psychological Testing||90865, 90870, 90875, 90876, 90880|
|New Patient Office Visit||99201, 99202, 99203, 99204, 99205|
|New Patient Consult||99241, 99242, 99243, 99244, 99245|
Additional services beyond the codes listed above require prior authorization before services are rendered; including office visits (99211-99215).
As a non-network provider, you should contact Provider Services to determine changes in benefits for your patients. Prior authorization requests must be submitted using the online prior authorization tool available on our bcbsms.com website beginning January 4, 2010. Please read the information below for instructions for non-network providers:
- Call our Provider Service area at 601-932-1122 or 1-800-257-5825 to verify eligibility and benefits.
- For members needing prior authorization, you will hear the following message: “Prior Authorization Required. Go to www.bcbsms.com to obtain the Mental Health & Substance Abuse Prior Authorization Request Form.”
- Go to www.bcbsms.com and click on the “i’m a provider" tab and then click on Provider Forms to locate the new Mental Health & Substance Abuse Prior Authorization Request form. You must use this form to submit a prior approval request.
a. Please note that this same form also applies to Federal Employee Program members.
- It is important that you complete all required fields so that the review and prior authorization process is not delayed.
- This new prior authorization tool will soon allow you to upload medical documentation to support the prior approval request.
- To track the status of your prior authorization, you should call our Care Management Team at 1-800-841-9659, extension 4009.
Note: Network providers should go to myAccessBlue to determine changes in benefits for your patients and to submit prior authorization requests.
It is important that you share this information with your office staff before January 1, 2010. If you have questions regarding the change, you may contact our Care Management Team at 1-800-841-9659, extension 4009.