BT2026151: IHCP clarifies billing guidance for providers enrolled as a CCBHC or CMHC

IMMEDIATE ACTION REQUIRED: Billing team must implement the following changes for all CCBHC and CMHC providers: 1. CCBHC PROVIDERS (All locations enrolled as CCBHC): - Update billing system logic to automatically select the provider's registered CCBHC NPI (field 33a on CMS-1500) for ALL services within CCBHC scope of services delivered within the designated CCBHC geographic county coverage area - For services outside CCBHC scope (residential services, AMHH, BPHC, CMHW) or services outside CCBHC geographic coverage area: use the CMHC NPI instead - Flag: Do NOT bill multiple claims on the same date of service for different service locations at CCBHC - these will be denied 2. CCBHC PROVIDERS (Mixed locations - some CCBHC, some CMHC only): - Route services within ANY CCBHC location's designated geographic coverage area through CCBHC NPI if service is in CCBHC scope - Route services outside ALL CCBHC geographic coverage areas through CMHC NPI (for both CCBHC and non-CCBHC locations) 3. ALL CCBHC/CMHC CLAIMS - CRITICAL REQUIREMENTS: - Include the billing provider's service location address in field 33 on CMS-1500 (or equivalent electronic field) - Include a valid CMS Place of Service (POS) code matching the actual location where service was rendered - For off-site services (e.g., in-home): Use originating clinic NPI/address in field 33, but enter the EXACT service location address in field 32 (or Service Facility Location ID for electronic claims). Inaccurate addresses will result in claim denial. - Do NOT list multiple locations in field 32 on a single claim 4. VERIFICATION AND TESTING: - Review current claim submissions to identify any incorrectly billed claims using wrong NPI for service type/location combination - Contact providers with mixed CCBHC/CMHC locations to obtain their designated CCBHC geographic coverage area boundaries - Test billing system rules to ensure NPI routing logic is correct before processing claims 5. PROVIDER COMMUNICATION: - Notify all CCBHC and CMHC providers of these requirements - Distribute the CCBHC encounter code list (available from myersandstauffer.com) to providers for reference - Remind providers to verify service location ZIP Code+4 accuracy for off-site claims CONSEQUENCES: Claims submitted with incorrect NPI, missing location address, invalid POS code, or inaccurate off-site location details will be denied. Multiple same-date-of-service CCBHC claims for different locations will be denied.