Optum has provided information to Valant regarding updated claim requirements for some commercial behavioral health plans. They have provided a Reimbursement for Supervisory Services Billing Reference Guide with details.
Effective Oct. 1, 2024, Optum will reimburse outpatient supervisory services claims covered by Commercial Behavioral Health plans as follows:
- California, Colorado, Iowa & Massachusetts – Both network and out-of-network providers and groups
- Other states – Only network providers and groups who have an existing, fully executed participation agreement on or before Sept. 30, 2024
This is not applicable to Medicare and Medicaid health plans. For information or questions about outpatient services rendered under supervision for Medicare or Medicaid plans, please refer to CMS guidelines and policies, as well as any state-specific policies that apply to Medicaid plans.
Required claim information:
- The DQ (Supervising Provider Qualifier) qualifier is required to be added to the claim in conjunction with the U5 modifier. This combination designates that behavioral health outpatient services have been performed under supervision.
- The U5 modifier is required for each service rendered under supervision. It can be noted in any modifier position. CMS-1500 Field
- Claims must also include the supervising clinician name, credentials and National Provider Identifier (NPI) number. Claims that do not include this information may be denied.
It is recommended that practices update Valant to ensure successful claim submission.
DQ Information
Navigate to Persons & Institutions | Insurance Companies | select insurance company | EDI Configuration tab. Check "Box 17 - DQ Qualifier".
Navigate to Billing | View/Edit Charges | select from list | Other Details tab. Select an Incident-To Supervisee. The required provider information will be pulled into Box 17.
Incident-To Supervisor field locations:
- Add or Edit Appointment. Select an Incident-To Supervisor.
- Persons & Institutions | Providers | select provider | Provider tab. Select and Incident-To Supervisor and ITB Supervisor Billing Type.
U5 Modifier Information
Modifiers can be added manually or automatically using Fee Schedules
Manual Options:
- From Add or Edit Appointment window: populate Modifiers (1-4) as appropriate
- From Billing | View/Edit Charges | select from list | Details tab | select from list | View/Edit Details button: populate Modifiers (1-4) as appropriate
Article for reference: Modifiers
Automatic Option:
Set up Fee Schedules with U5 Modifier added to transaction codes: example image shown below
Note: After setting up the fee schedule, click Update Unrecorded Appointments with the start date of 10/1/2024.
Article for reference: Financial Class and Fee Schedules Overview
For Questions on application of these requirements to specific health plans, Contact your Provider Advocate or refer to the state-specific contact listing. You may also call the Provider Services Line at (877) 614-0484.
If you need more help contact Valant support.