Mental Health Services

Billing codes and payment policies

Pre-authorization is key

  1. Use the preauthorization form to request authorization to provide services.
  2. When you receive your authorization, check the authorized dates of service. If they are different from what you expected, contact the Claim Manager immediately. Do not provide services beyond the authorized dates.
  3. Request an extension 2 weeks before the end of the currently authorized period to reduce the possibility of a disruption in care.
  4. Additional treatment is more likely to be authorized if your notes/reports clearly show the injured worker is improving as a result of the therapy.

Other billing information

  1. Find out how to bill self-insured employers and (see a list of employers)
  2. Use ICD-10 codes. Bill these codes the same as for all other insurers.
  3. Bill electronically, if at all possible. L&I offers a free electronic billing application for State Fund claims. Electronically submitted bills process faster.
  4. The dates of service must be within the authorized date span. Other dates will not pay.
  5. Use the diagnosis allowed on the claim. If you are making a new diagnosis, or adding one, use the currently allowed diagnosis on the bill, then discuss the new diagnosis with the claim manager. Note: When doing an assessment, a mental health condition may not yet be allowed. Use the diagnosis you make in the assessment.
  6. Use procedure codes that are current on the date of service.
  7. Bill for the work you do including phone calls, reviewing job analysis and return to work offers, electronic communications (via Claim & Account Center) and 60-day reports with L&I local codes. Note: Some third-party billers do not bill local codes, so you may need to bill them separately.
  8. Monitor your submitted bills in the Claim and Account Center. Most mental health providers will need to request temporary access from the claim manager.

 

 

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