Behavioral health provider billing
Billable behavioral health services are reimbursed fee-for-service. Standard Behavioral Health fees are listed on our Fee schedules page (login required).
In general, follow billing rules for all practitioners using a CMS-1500 claim form.
Practitioners must be credentialed by Priority Health in order for services to be covered as an in-network benefit.
Behavioral health practitioner credentialing requirements
These providers must be credentialed to bill Priority Health:
HMO/EPO/POS/PPO plans: MD/DO psychiatrists/addictionologists, licensed psychologists, LMSWs, LPCs and LLPs
Medicaid plans: MD/DO psychiatrists/addictionologists, licensed psychologists, LMSWs, LPCs and LLPs
Medicare Advantage plans: MDs/DOs, licensed psychologists and LMSWs
Limited license practitioners
LLMSWs, LLPCs and TLLPs cannot be credentialed. They cannot bill for out-of-network PPO or POS services. The only limited license practitioners that can bill are limited licensed psychologist.
Behavioral health services directly rendered by another practitioner
With the exceptions noted below, the field 24J (rendering provider) on the CMS-1500 claim form must show the individual NPI number of the practitioner who directly provides the service being billed. For example, a licensed psychologist cannot be shown as the rendering provider for services directly provided by a limited license psychologist (LLP) whom they are supervising.
Exceptions to the credentialing and supervision requirements
Exceptions to the credentialing and supervision/rendering provider billing rules are:
- Psychotropic medication management services:
Psychiatric advanced practice providers, e.g., CNS, NP, PA, directly providing these services, do not require credentialing by Priority Health. Bill with their supervising/collaborating psychiatrist as the rendering provider.
- Psychological testing:
When testing is directly provided by an LLP, bill with the supervising licensed psychologist as the rendering provider.
- Organizational providers: See below
Credentialing exception: When working in an accredited organization that is credentialed as an Organizational Provider by Priority Health, appropriately licensed behavioral health practitioners do not require individual credentialing by us.
Before a new provider who meets our criteria can see a Priority Health member (and before the organization bills us for that provider's services), you must notify us in writing that the provider has been added to your contract.
- Use the Provider Change Form
We notify you when we have added the provider. Claims with dates of service before the notification date will deny.
Bill with their own individual NPI number as the rendering provider for any services they provide directly.
Provider record and billing reviews
Priority Health reviews claims data to identify and monitor suspect patterns as part of our fraud, waste and abuse program.
Providers may be flagged for reviews for:
- Excessive billing of high-level codes
- Exclusive use of one code level billed
- Excessive units for a time-based code
Submitting electronic claims
Mailing paper claims
Priority Health Claims
P.O. Box 232
Grand Rapids, MI 49501
- Status claims
- Claims Inquiry tool guide
- Edits Checker tool guide
- Claim deadlines
- Set up electronic payments
- BH provider billing
- Facility billing
- Advanced practice professional billing
- Professional billing
More billing topics:
- ACA non-payment grace period
- Balance billing
- Clinical edits
- Check reissue procedure
- COB: Coordination of benefits
- Correcting claims
- Correcting overpayments & underpayments
- Diagnosis coding
- Dual-eligible members
- Front-end rejections
- Gender-specific services
- Medicaid billing
- NDC numbers on drug claims
- Office-based procedures billing
- Risk adjustment
- Unlisted codes, drugs & supplies