Coverage of Collaborative Care Model Statewide for HealthChoice and Medicaid Fee-for-Service Enrollees-FQHC, Effective October 1, 2023

REQUIREMENTS: - Immediately: Billing team must update billing system to recognize and process CPT code G0512 for FQHC CoCM services at the reimbursement rate of $145.08 per unit for Maryland Medicaid (both HealthChoice MCO and Fee-for-Service). Ensure system allows only one G0512 billing code per patient per month. - Before accepting CoCM claims: Providers must verify patient eligibility (full benefits through HealthChoice MCO or FFS Medicaid enrollment with diagnosis of mild-to-moderate anxiety, depression, or SUD) and contact the behavioral health ASO at 1-800-888-1965 to confirm patient is not already receiving duplicate specialty behavioral health services. Document ASO coordination in patient record. - By next enrollment cycle: Ensure all primary care providers billing for CoCM services at your FQHC are enrolled with Maryland Medicaid via ePREP. Only enrolled PCPs can bill for these services. - Immediately: Update provider documentation and attestation processes to confirm that providers billing G0512 have reviewed standard CoCM guidelines and are implementing services consistent with those guidelines (PCP + behavioral health care manager + psychiatric consultant model with validated clinical rating scales and systematic psychiatric reviews). - Before submitting claims: Confirm that CoCM billing is submitted under the PCP's name and provider number only; only the PCP can bill for CoCM services. - Ongoing: Monitor MCO reimbursement rates to ensure they meet or exceed the FFS rate of $145.08 per unit; report underpayment to MCO contracts manager for negotiation. Failure to comply will result in claim denials, duplicate billing penalties, and potential provider enrollment sanctions.