Billing Process for Services Provided to DMH-Funded Consumers -- 314.206.3880
Applicable to services provided beginning January 1, 2006, and any outstanding billing that has not been received by February 1, 2006.
Providers must use a CMS 1500 (formerly HCFA 1500) or a spreadsheet. Spreadsheets must include all CMS 1500 information.
Providers can now bill BJC BH as often as desired in either approved method. Using a BJC BH invoice form is no longer required. Providers may use Common Procedural Terminology (CPT) and Health-Care Common Procedure Coding System (HCPCS) codes where applicable.
Each visit billed must include a copy of the session notes.
BJC BH quarterly progress notes are no longer required. Minimum progress notes will include:
- Date and time taken to deliver the service -- time can be stated as start and stop time or duration
- List and dosage of current medications or current medication log
Note: The requirements for Psychosocial Rehabilitation (PSR) services remain unchanged. An individual service note is not required.
Billing for Medicare consumers should include an Explanation of Benefits (EOB) from Medicare and -- where applicable -- Medicaid.
BJC BH will deduct the amount of the payment(s) received from the amount paid to the provider. If an EOB is not included, BJC BH will deduct the standard Medicare payment -- 50 percent of the maximum Medicare allowable rate -- for consumers who are reflected in our billing system as having Medicare without crossover. For consumers with Medicare crossover, BJC BH will deduct the full Medicare allowable rate from the provider payment. Learn more about deductions for Medicare and Medicaid payments.
If payment is not received from Medicare or Medicaid, a copy of the EOB highlighting the unpaid service should be sent to BJC BH. We will reimburse the provider for the balance of the contracted amount.
Consumers must be active with BJC BH on the date of service.
Providers will continue to receive authorizations and notice of discharge from BJC BH. Providers can verify consumer status by calling 314.206.3890.
BJC BH contacts providers regarding claims for consumers who were inactive on the date of service billed. The goal is for all consumers -- seen by the provider -- to be active with BJC BH on the date of service. BJC BH will begin sending monthly discharge reports to providers.