CommercialDocumentationMedium impact
Enhance Behavioral Health Outcomes
Florida Blue·FL · Psychiatry, Emergency Medicine, Internal Medicine +1 more·Specialty Services
Effective date
Jul 1, 2026
We identified it
Jul 2, 2026
Summary
Florida Blue is implementing enhanced performance tracking on five HEDIS behavioral health quality measures (IET, FUM, FUH, FUI, FUA) effective July 2026. Providers must ensure timely follow-up care within 7-30 days after ED visits or hospitalizations for mental illness and substance use disorders, and coordinate care through available resources including Lucet Behavioral Health Network and case management services. This is a quality/outcomes tracking initiative rather than a billing code or coverage change, but non-compliance with follow-up requirements may impact quality scores and future reimbursement.
Action Required
By July 1, 2026: Clinical and care coordination teams must implement processes to ensure behavioral health follow-up visits occur within 7-30 days post-ED visit or hospitalization. Specific actions: (1) Update EMR templates and encounter forms to include behavioral health follow-up scheduling reminders for providers treating mental illness or SUD diagnoses; (2) Establish coordination protocols with Lucet Behavioral Health (case management: 1-866-350-2280; member services: 1-866-287-9569); (3) Train clinical staff on the five HEDIS measures (IET, FUM, FUH, FUI, FUA) and documentation requirements; (4) Monitor quality metrics via Florida Blue reporting to identify gaps; (5) Billing team should flag claims for mental illness/SUD ED visits and hospitalizations to ensure corresponding follow-up visit claims are submitted within required timeframes. Failure to demonstrate follow-up within timeframes will negatively impact HEDIS quality scores, which may affect future contracting, incentive payments, and quality bonuses.