CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Payment Policy Behavioral Health Integration Services including the Collaborative Care Model

Defines Blue Cross Blue Shield of Rhode Island's reimbursement/payment approach for behavioral health integration services including the collaborative care model for applicable providers and members.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyBehavioral Health Integration Services payment policy

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateAug 1, 2024

Next Review DateOct 16, 2024

Key ActionVerify member benefits and eligibility by calling the provider call center before delivering services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

5Provider Updates published (years listed)

0References listed

Coverage and Medical Necessity

Coverage governance

Covered when ALL of the following are met:

ALL of the following

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Provider Responsibilities and Billing

Prior Authorization

Verify member benefits and eligibility

For member-specific benefits and eligibility, providers should call the provider call center; benefits and eligibility are determined by the member's subscriber agreement, member certificate, and/or the employer agreement which supersede this policy.

Billing Rule

Member financial responsibility for non-covered services

Providers may not charge members for services determined to be not medically necessary or non-covered unless the member was informed in advance and agreed to continue at their own expense; refer to participation agreements for details.

Policy Purpose and Limitations

Policy purpose and limitations

Policy statusThis medical policy is informational and is not a guarantee of payment; it is made available for informational purposes only and is not a substitute for medical judgment.

Governing documentsBenefits and eligibility are determined by the member's subscriber agreement, member certificate, and/or the employer agreement, which supersede this policy.

Member-specific verificationFor information on member-specific benefits and eligibility, providers should call the provider call center.

Charging members for non-covered servicesProviders may not charge members for services determined to be not medically necessary (or for some medically necessary services that are non-covered) unless the member was informed in advance and agreed to continue at their own expense; refer to participation agreements for details.

Policy revisionsBCBSRI reserves the right to review and revise this policy at any time, with or without notice.