CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Behavioral Health Services - Inpatient and Intermediate Levels of Care payment policy

Defines program requirements and payment policy for bundled services that are part of inpatient and intermediate behavioral health services (inpatient mental health and substance abuse treatment, residential treatment, PHP, IOP, AIS, CFIT) for Blue Cross & Blue Shield of Rhode Island members.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyBehavioral Health Services - Inpatient and Intermediate Levels of Care payment policy

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateAug 1, 2018

Next Review DateN/A

Key ActionNotify the BCBSRI Behavioral Health vendor within 48 hours of admission and discharge and follow authorization requirements for out-of-network services as specified.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1-800-274-2958Behavioral Health vendor contact for notification/authorization

48 hoursrecommended notification window for admission and discharge to Behavioral Health vendor

6minimum required contacts for AIS/CFIT (4 face-to-face clinical, 2 care coordination)

Policy scope and summary

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

This policy from Blue Cross & Blue Shield of Rhode Island defines program requirements and the payment policy for bundled services that are part of inpatient and intermediate behavioral health services. It applies to inpatient mental health and substance abuse treatment, residential treatment, partial hospitalization (PHP), intensive outpatient programs (IOP), adult intensive services (AIS), and child and family intensive treatment (CFIT) for members in RI. Benefits may vary by contract, so member-specific coverage should be confirmed against the member’s Evidence of Coverage or Subscriber Agreement. For member-specific benefit questions providers may contact the provider call center or the BCBSRI behavioral health vendor at 1-800-274-2958.

Inpatient and intermediate levels of care — program definitions

Definitions

Inpatient care servicesInpatient mental health and substance abuse treatment as well as substance abuse and mental health residential treatment provided in a locked or staff-secured 24-hour clinical setting.

Intermediate care servicesIncludes hospitalization programs (PHP), intensive outpatient programs (IOP), adult intensive services (AIS), and child and family intensive services (CFIT); provides substantial clinical support in less restrictive settings to transition members or prevent inpatient admission.

Bundled servicesServices included in the per diem or treatment program payment, encompassing professional and facility services while the member is enrolled in the program, including on-site labs, therapy, and psychiatric treatment.

Billing rules and coding notes

Billing Rule

Bundling rules

All intermediate care services are included in the per diem or treatment program payment; this payment covers all professional and facility services performed while the member is enrolled, including on-site laboratory services. Off-site confirmatory or quantitative laboratory tests must be ordered by the prescribing clinician directly providing care and are covered only according to the BCBSRI Testing policy.

“All intermediate care services are bundled in the per diem or treatment program codes… This includes all laboratory services performed on site.”
“Confirmatory and quantitative laboratory services not able to be performed on site… must be ordered by a prescribing clinician directly providing care for the involved member and will be covered only according to the BCBSRI policy for Testing.”

Coding is not applicable for this policy. Benefits may vary by contract and member-specific benefits should be confirmed against the applicable Evidence of Coverage or Subscriber Agreement. For member-specific benefit questions, providers should contact the provider call center; the behavioral health vendor phone number is 1-800-274-2958.

What providers must do

Prior Authorization

Notification / Authorization requirements

In‑network: notify the BCBSRI Behavioral Health vendor of admission and of discharge (notification to the vendor within 48 hours after admission and within 48 hours after discharge is recommended). Out‑of‑network: authorization is required for BlueCHiP for Medicare and recommended for Commercial products; authorizations for out‑of‑network services are handled by the Behavioral Health vendor.

Behavioral Health vendor: 1-800-274-2958

Documentation Required

Licensure / Accreditation requirements for facilities

Facilities must hold an active state license for the state where services are provided and hold Joint Commission accreditation and meet BCBSRI credentialing/qualification requirements. For residential, PHP, and IOP: if no state license is offered, the provider must be accredited by CARF or the Joint Commission for mental health services or meet ASAM standards; providers that meet Joint Commission/CARF standards but lack accreditation will be reviewed and considered by the BCBSRI Behavioral Health Department.

Documentation Required

AIS/CFIT service requirements

AIS and CFIT programs must provide ongoing emergency/crisis evaluations, psychiatric assessment, medication evaluation and management, case management, psychiatric nursing services, and individual, group, and family therapy. The program requires a minimum of six (6) contact hours per week: four (4) face‑to‑face clinical hours and two (2) care coordination/collateral hours.

Required services: emergency/crisis evaluations; psychiatric assessment; medication evaluation/management; case management; psychiatric nursing; individual, group, and family therapy
Minimum contacts: 6 contact hours/week (4 face-to-face clinical; 2 coordination/collateral)

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyBehavioral Health Services - Inpatient and Intermediate Levels of Care payment policy

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateAug 1, 2018

Next Review DateN/A

Key ActionNotify the BCBSRI Behavioral Health vendor within 48 hours of admission and discharge and follow authorization requirements for out-of-network services as specified.

SourceLink

On This Page

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Behavioral Health Services - Inpatient and Intermediate Levels of Care payment policy

Policy scope and summary

Inpatient and intermediate levels of care — program definitions

Billing rules and coding notes

What providers must do

Numeric and clinical thresholds

Policy dates & review

Behavioral Health Services - Inpatient and Intermediate Levels of Care payment policy

Policy scope and summary

Inpatient and intermediate levels of care — program definitions

Billing rules and coding notes

What providers must do

Numeric and clinical thresholds

Other policies to read

Policy dates & review