Behavioral Health Service Organizations (BHSO) - PT 03

Behavioral Health Service Organizations (BHSO) - PT 03

KY Medicaid classifies behavioral health services (BHSO) as provider type (03). To enroll in or bill Kentucky Medicaid, BHSO service providers must be:

Covered Services

BHSO services are medically necessary services provided by behavioral health specialists through face-to-face interaction with a beneficiary who has a mental and/or substance abuse disorder. Services include assessment, service planning, Individual outpatient therapy, group outpatient therapy, collateral outpatient therapy and crisis intervention services, family outpatient therapy and other behavioral health services.

BHSO must meet coverage provisions and requirements of 907 KAR 15:020 and 907 KAR 15:022 to provide covered services. Any services performed must fall within the scope of practice for the provider. Listing of a service in an administrative regulation is not a guarantee of payment. Providers must follow KY Medicaid regulations. All services must be medically necessary.

Verifying eligibility

Verify eligibility by contacting the automated voice response system toll-free at (800) 807-1301 or use the web-based KYHealth-Net System.

Reimbursement

Reimbursement for BHMSG services as described in the Behavioral Health Fee Schedule and 907 KAR 15:015.

Duplication of Service

The department will not reimburse for a service provided to a beneficiary by more than one provider of any program in which the same service is covered during the same time period.

Prior Authorizations

CareWise provides prior authorizations for fee-for-service (FFS) beneficiaries. Each MCO provides prior authorization for its beneficiaries.

Claims Submission

KY Medicaid currently contracts with DXC to process FFS claims. Each MCO processes its own claims.

Coding

Kentucky Medicaid uses the National Correct Coding Initiative (NCCI) edits as well as the McKesson Claim Check System to verify codes mutually exclusive or incidental. Kentucky Medicaid also uses Current Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding system (HCPCS) codes. Kentucky Medicaid requires the use of ICD-10 codes on all claims submitted for reimbursement. Kentucky Medicaid requires the use of CMS 1500 billing forms. Providers must bill Kentucky Medicaid using the correct CPT codes.

Claim Appeals

Appeal requests of denied FFS claims must be submitted to DXC. The appeal request must include the reason for the appeal along with a hard copy claim. Please refer to the MCO when appealing an MCO claim.

Timely Filing

Claims must be received within 12 months of the date of service or six months from the Medicare pay date, whichever is longer, or within 12 months of the last Kentucky Medicaid denial. Please refer to the MCO when appealing an MCO claim.

Provider Contact Information

If you can't find the information you need or have additional questions, please direct your inquiries to:
FFS Billing Questions - DXC - (800) 807-1232
Provider Questions - (855) 824-5615
Prior Authorization - CareWise - (800) 292-2392
Provider Enrollment or Recertification - (877) 838-5085
KyHealth.net assistance - DXC - (800) 205-4696
CHFS DMS BH and SU Inquires - (502) 564-6890
Pharmacy Questions - (800) 432-7005
Pharmacy Clinical Support Questions - (800) 477-3071
Pharmacy Prior Authorization - (800) 477-3071
Physician Administered Drugs (PAD) list - Pharmacy Branch - (502) 564-6890

Provider MCO Information

Anthem - (800) 205-5870 
Aetna Better Health of KY - (855) 300-5528 
Humana - (855) 852-7005
Passport Health Plan- (800) 578-0775
WellCare of KY - (877) 389-9457

​Report Fraud and Abuse

(800) 372-2970

Regulations

902 KAR Cabinet for Health and Family Services  - Public Health Title page

902 KAR 20:430 Facilities specifications, operation, and services; behavioral health services organizations

907 KAR - Cabinet for Health and Family Services - DMS Title page

907 KAR 3:130 Medical necessity and clinically appropriate determination basis

907 KAR 15:015 Reimbursement provisions and requirements for behavioral health services provided by individual behavioral health providers, behavioral health provider groups, or behavioral health multi-specialty groups

907 KAR 15:020 Coverage provisions and requirements regarding services provided by behavioral health services organizations

907 KAR 15:022 Coverage provisions and requirements regarding services provided by behavioral health services organizations for substance use disorder treatment and co-occurring disorders

908 KAR Cabinet for Health and Family Services - Department for Behavioral Health Developmental and Intellectual Disabilities - Title page

908 KAR 1:372  Licensing procedures, fees, and general requirements for nonhospital-based alcohol and other drug treatment entities

908 KAR 1:374 Licensure of nonhospital-based outpatient alcohol and other drug treatment entities

Provider Resources

PT - 03 BHSO Provider Summary

Provider Letters

Provider Letter #A-15: Service Facility Location

Provider Letter # A-113: Buprenorphine Coverage

Provider Letter #A-106: COVID-19 Guidance - Telehealth

Provider Letter A-105: COVID-19 Guidance for all Medicaid Providers 

Notification of KY Medicaid Partner Portal Application (KYMPPA) Update 

Multi Behavioral Health Provider Letter - Revisions to Behavioral Health and Substance Abuse Services fee Schedules

Behavioral Health and Substance Abuse Services Fee Schedules 

General Provider Letter #A-103 - IMD Expansion

Provider Letter regarding Ordering, Referring Prescribing Providers 

Billing Instructions

Provider Billing Instruction Home 
BHSO Billing Manual

Fee and Rate Schedules

Fee and Rate Schedule Home

2022 Behavioral Health and Substance Abuse Services Inpatient (Facility​) 

2022 Behavioral Health and Substance Abuse Services Outpatient (Non-facility)

2021 Behavioral Health and Substance Abuse Services Inpatient (Facility) 

2021 Behavioral Health and Substance Abuse Services Outpatient (Non-facility)

20​20 Behavioral Health and Substance Abuse Services Inpatient (Facility)  

2020 Behavioral Health and Substance Abuse Services Outpatient (Non-facility) ​

Contact Information

53