BCBSAL Federal Providers

2010 FEP BENEFIT CHANGES FOR OUTPATIENT MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES

As a reminder, effective January 1, 2010, members participating in the Federal Employees Health Benefits Program (FEP) are now required to have prior approval for all outpatient mental health and substance abuse services. Excluded are visits for pharmacotherapy (medication management - CPT Code 90862) or psychological testing (CPT Codes 96101, 96102, and 96103). For members that are new to your practice, demographic information and any presenting symptoms that are obtained when the member's appointment is made may be submitted in order to start the certification process. Once the member has been evaluated, a full treatment plan should be submitted to Blue Cross and Blue Shield of Alabama's Health Management Area. A copy of the certification form may be obtained by going to Blue Cross' web site at www.bcbsal.org and selecting "I AM A PROVDER". The form is located under the Provider Resources section and then clicking on Forms / Psychiatric / Psychiatric Outpatient Certification.

In order to better serve you and our members, treatment plans will be accepted beginning each January of the new year and run thru June 30(6 month period). A maximum of 8 visits will be reviewed at a time, with additional visits reviewed upon the submission of updated clinical information. A new treatment plan is requested for 7/1 thru 12/31, if continued care is required. Treatment plans will be processed in the order that they are received. Once reviewed, you will be notified of our decision and claims will be processed based on the member's benefits.

The submission of a treatment plan does not guarantee payment and is subject to the availability of benefit coverage at the time services are rendered. Treatment plans will be subject to utilization review and may be submitted for peer review if medical necessity cannot be established.

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Dear Provider:

American Behavioral is grateful for your participation in our network of providers. We want to thank you for your service to our members and their families, as well as working with us as we move forward with electronic claims processing, adapt to the coming Parity regulations and work to lessen your administrative burden when it comes to outpatient authorization.

We have been evaluating process improvement measures that should decrease the administrative requirements for authorization of outpatient visits. Hopefully, we will be able to announce the implementation of these improvements in the near future.

American Behavioral is pleased that the employers we serve continue to be supportive of providing behavioral health care benefits to their employees and dependents. To date, American Behavioral client organizations have not dropped mental health or substance abuse treatment benefits, though this is allowed under Parity. Full Parity will go into effect on January 1, 2010, for the majority of our client organizations. Agreements between American Behavioral and these organizations have been revised to be compliant with Parity. Those client organizations not affected by Parity on January 1, 2010, will come under these regulations as their contracts renew throughout the year.

American Behavioral will be adding many new client organizations in 2010. This will equate to approximately 100,000 additional covered lives. Some of our new client organizations include:

· City of Gulf Shores

· City of Hoover

· Dynetics

· Energen

· ERC

· Jim Walter Resources, Alabama

· Jim Walter Resources, Florida

· Mitchell Grocery

· Tec-Masters

· Baptist Hospital Montgomery

· Managed Care for Belk in the State of Alabama (American Behavioral already administers Belk's Employee Assistance Program [EAP] services nationally.)

Effective January 1, 2010, the Blue Cross Blue Shield of Alabama (BCBSAL) BlueCard Host Network, HealthSouth and Mueller contracts will no longer be administered through American Behavioral. These contracts will be transitioned to the new Blue Choice Behavioral Health Network. American Behavioral will work with you to ensure that claims for services rendered through December 31, 2009, involving the three contracts listed above will be processed and paid accordingly. This will not affect the Federal Employee Program that is administered through American Behavioral.

Providers who are not participating with the Blue Choice Behavioral Health Network are encouraged to begin communicating this change to their patients in order to promote a smooth transition. For assistance in locating a participating provider, members may contact the customer service number listed on the back of their identification cards or access the Blue Cross website at www.bcbsal.org.

For more information regarding the Blue Choice Behavioral Health Network, please contact the Managed Health Care Administration at 1-866-334-6422 or (205) 968-8651. If you need to speak with a Blue Cross and Blue Shield Provider Representative, please call (205) 220-7200.

Again, American Behavioral will continue to administer the BCBSAL Federal Employee Program. Also, American Behavioral will continue to administer EAP benefits for HealthSouth.

American Behavioral looks forward to serving you in the future. We hope you have a healthy and prosperous 2010.