Medicaid billing by Provisionals

PROVISIONAL MENTAL HEALTH PROVIDERSMedical Billing for Medicaid

Senate File 102, now Senate Enrolled Act 21, was passed during the 2015 Legislative General Session amending current Medicaid statute 42-4-102 (A) (xx). The revised statute specifies that services provided by a person holding a provisional license as a mental health professional are authorized for Medicaid reimbursement if performed under the supervision of a licensed mental health professional. The bill provides a definition of “licensed mental health professional” as a licensed professional counselor, a licensed marriage and family therapist, a licensed addiction therapist or a licensed clinical social worker. The effective date of the legislative change is July 1, 2015.

 

Effective July 1, 2015 the following provisional licensed mental health professionals may enroll and bill Medicaid for covered services if performed under the supervision of a licensed mental health professional.

 

Provisional Licensed Addictions Therapist (PLAT)
Provisional Clinical Social Worker (PCSW)
Provisional Marriage and Family Therapist (PMFT)
Provisional Professional Counselor (PPC)

 

In order for Medicaid to properly implement this change, a number of programmatic changes must first be deployed. These changes include the following:

 

1. Emergency Rule Promulgation
2. Provider Outreach and Education
3. Provider Manual Revision
4. Claims Systems Editing
5. Enrollment Policy Changes

 

Wyoming Medicaid is currently on track to fully implement this effective July 1, 2015.

 

It is essential that Licensed Mental Health Providers review and understand the provider responsibilities as outlined in the following:

 

The Medicaid Provider Agreement
The Medicaid Provider Certification
The CMS-1500 Provider Manual

 

Chapter 1-5 Provider Responsibilities
Chapter 6 – Billing
Chapter 7 – TPL
Chapter 8 & 9 – Electronic Data Interchange (EDI) and Wyoming Specific HIPAA 5010
Chapter 10 – Medicaid Covered Services
Appendices

 

Information regarding updates to your current provider enrollment such as group or supervision changes or contact information, please contact Provider Relations for assistance after July 1st, 2015 at 1-800-251-1268.

Janet de Vries

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