Medicare AdvantagePrior AuthMedium impact
MAPAP254 - Partial Hospitalization Program (PHP) - Updated policy verbiage throughout to reflect current Medicare guidelines. Added verbiage regarding staff licensing and supervision within PHP programs.
Blue Cross of Idaho·ID · Psychiatry·Medical Policy
Effective date
Jan 1, 2025
We identified it
Jun 19, 2026
Summary
Blue Cross of Idaho updated their Partial Hospitalization Program (PHP) policy to align with current Medicare guidelines and added new requirements for staff licensing and supervision documentation. The policy clarifies that PHP services require prior authorization and must be provided in Medicare-certified facilities with properly licensed and supervised staff.
Action Required
Immediately: Billing team must ensure all PHP claims include proper prior authorization before submission. Verify that PHP services are only billed when provided in hospital outpatient departments or Medicare-certified Community Mental Health Centers. Update billing workflows to confirm staff licensing and supervision requirements are met before processing PHP claims, as claims may be denied without proper documentation.