CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Behavioral Health Supervisory Protocol for Licensed Clinical Social Workers and Post Doctorate Clinicians

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Governs the process by which Licensed Clinical Social Workers (LCSWs) and Post Doctorate Clinicians may render outpatient behavioral health services under supervision of a BCBSRI-credentialed independently licensed behavioral health clinician; affects credentialed outpatient professional providers and supervisees rendering services to BCBSRI members.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyBehavioral Health Supervisory Protocol for Licensed Clinical Social Workers and Post Doctorate Clinicians

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJan 1, 2023

Last ReviewJan 2, 2023

Next Review DateN/A

Key ActionSubmit a supervisory protocol and required documentation to Behavioralhealth@bcbsri.org and obtain approval prior to supervisee rendering reimbursable services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

HO, HPRequired claim modifiers

Submission requiredProtocol submission

3+ elementsMinimum protocol elements

Commercial & MedicareMember types

Supervised Behavioral Health Services Coverage Criteria

Supervised services coverage criteria

Covered when ALL of the following administrative and supervision requirements are met:

Applicability: Benefits may vary by group/contract; refer to the Evidence of Coverage or Subscriber Agreement for member‑specific benefits, deductibles, and copayments

Member types: Services may be rendered to Commercial and Medicare Members; for Medicare, BCBSRI follows CMS guidance on direct supervision (physician present in the office suite and immediately available)

Billing Modifiers and Claims Submission

Supervision modifiersModifier

HO	Modifier to indicate services rendered by an LCSW
HP	Modifier to indicate services rendered by a Post Doctorate Clinician

Claims submission requirement

Claim submitterClaims must be submitted by the independently licensed, BCBSRI-credentialed clinician.

Required modifier for LCSW servicesHO modifier must be included to indicate services rendered by an LCSW.

Required modifier for Post Doctorate Clinician servicesHP modifier must be included to indicate services rendered by a Post Doctorate Clinician.

Coding standards referenceBCBSRI follows CMS and CPT coding/payment guidelines; refer to Behavioral Health Outpatient Professional Services payment policy for CPT codes.

Prior Notification and Supervisory Protocol Submission

Prior Authorization

Prior Authorization Required / Supervisory Protocol Submission

Notification of admission is required for some behavioral health outpatient professional services. Contact BCBSRI's Behavioral Health Utilization Management at 800-274-2958. All supervisory protocols must be submitted to Behavioralhealth@bcbsri.org prior to services being rendered by an LCSW or Post-Doctorate Clinician for reimbursement.

Providers must notify BCBSRI for required admissions to behavioral health outpatient professional services: call 800-274-2958.
Supervisory protocol submission required prior to LCSW or Post-Doctorate Clinician rendering reimbursable services.
Submission address: Behavioralhealth@bcbsri.org (include a cover sheet).
Required elements to include with supervisory protocol cover sheet:
- Documentation that the supervising clinician is credentialed with BCBSRI.
- Written clinic policy describing the supervisory protocol.
- Process for review of patient treatment documentation by the BCBSRI credentialed supervisor (assessment, treatment plan, and any diagnosis changes).
- Documentation that the patient is informed and aware a non-credentialed clinician is providing services.
- Process supporting regular supervisor–supervisee meetings per Rhode Island Department of Health guidelines.
Also include: Tax ID and National Provider Identifier (NPI).
Note: BCBSRI does not credential LCSWs or Post-Doctorate Clinicians; credentialed outpatient professional providers must submit and receive approval for the supervisory protocol.

Supervisory Protocol Definition

Supervisory protocol — core components

PurposeDefines the process by which a BCBSRI-credentialed outpatient professional ensures non-licensed clinicians (LCSW, Post Doctorate Clinician) are duly supervised.

Required submission and approvalSupervisory protocol must be submitted to Behavioralhealth@bcbsri.org and receive BCBSRI approval prior to supervisee rendering reimbursable services.

Credentialing documentationProtocol must document that the supervising clinician is credentialed with BCBSRI and include Tax ID and NPI.

Written policy and documentation reviewMust include a written supervisory policy and the process for review of patient treatment documentation (assessment, treatment plan, diagnosis changes) and patient notification that the clinician is not BCBSRI-credentialed.

Supervisor-supervisee meetingsProcess must support regular supervisor-supervisee meetings in accordance with Rhode Island Department of Health guidelines.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyBehavioral Health Supervisory Protocol for Licensed Clinical Social Workers and Post Doctorate Clinicians

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJan 1, 2023

Last ReviewJan 2, 2023

Next Review DateN/A

Key ActionSubmit a supervisory protocol and required documentation to Behavioralhealth@bcbsri.org and obtain approval prior to supervisee rendering reimbursable services.

SourceLink

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Behavioral Health Supervisory Protocol for Licensed Clinical Social Workers and Post Doctorate Clinicians

Customize your policy alerts

Sign up for all Blue Cross Blue Shield - Rhode Island policy alerts

Know when Blue Cross Blue Shield - Rhode Island releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Supervised Behavioral Health Services Coverage Criteria

Supervised services coverage criteria

Covered when ALL of the following administrative and supervision requirements are met:

Applicability: Benefits may vary by group/contract; refer to the Evidence of Coverage or Subscriber Agreement for member‑specific benefits, deductibles, and copayments

Billing Modifiers and Claims Submission

Supervision modifiersModifier

HO	Modifier to indicate services rendered by an LCSW
HP	Modifier to indicate services rendered by a Post Doctorate Clinician

Claims submission requirement

Claim submitterClaims must be submitted by the independently licensed, BCBSRI-credentialed clinician.

Required modifier for LCSW servicesHO modifier must be included to indicate services rendered by an LCSW.

Required modifier for Post Doctorate Clinician servicesHP modifier must be included to indicate services rendered by a Post Doctorate Clinician.

Coding standards referenceBCBSRI follows CMS and CPT coding/payment guidelines; refer to Behavioral Health Outpatient Professional Services payment policy for CPT codes.

Prior Notification and Supervisory Protocol Submission

Prior Authorization

Prior Authorization Required / Supervisory Protocol Submission

Providers must notify BCBSRI for required admissions to behavioral health outpatient professional services: call 800-274-2958.
Supervisory protocol submission required prior to LCSW or Post-Doctorate Clinician rendering reimbursable services.
Submission address: Behavioralhealth@bcbsri.org (include a cover sheet).
Required elements to include with supervisory protocol cover sheet:
- Documentation that the supervising clinician is credentialed with BCBSRI.
- Written clinic policy describing the supervisory protocol.
- Process for review of patient treatment documentation by the BCBSRI credentialed supervisor (assessment, treatment plan, and any diagnosis changes).
- Documentation that the patient is informed and aware a non-credentialed clinician is providing services.
- Process supporting regular supervisor–supervisee meetings per Rhode Island Department of Health guidelines.
Also include: Tax ID and National Provider Identifier (NPI).
Note: BCBSRI does not credential LCSWs or Post-Doctorate Clinicians; credentialed outpatient professional providers must submit and receive approval for the supervisory protocol.

Supervisory Protocol Definition

Supervisory protocol — core components

PurposeDefines the process by which a BCBSRI-credentialed outpatient professional ensures non-licensed clinicians (LCSW, Post Doctorate Clinician) are duly supervised.

Required submission and approvalSupervisory protocol must be submitted to Behavioralhealth@bcbsri.org and receive BCBSRI approval prior to supervisee rendering reimbursable services.

Credentialing documentationProtocol must document that the supervising clinician is credentialed with BCBSRI and include Tax ID and NPI.

Supervisor-supervisee meetingsProcess must support regular supervisor-supervisee meetings in accordance with Rhode Island Department of Health guidelines.