Fee schedule change for non-physician Medicaid behavioral health services
Effective Oct. 1, 2025, our standard Medicaid reimbursement for all non-physician behavioral health providers (i.e., LP, LMSW, LPC, LLP, LMFT) will align with industry standards and be based on MDHHS’ Non-Physician Behavioral Health Fee Schedule, rather than the Practitioner/Medical Clinic Fee Schedule currently used.
Billing policy reminders
We’re reminding our provider network about several billing policies and requirements as we’ll soon implement clinical edits in alignment with the outlined information.
July 2025 billing policy updates
The following billing policies were recently published to or updated in our Provider Manual’s Billing Policies page.
Medicare therapy cap changes effective Jan 1 2025
Starting Jan. 1, 2025, we're changing our Medicare therapy caps for physical, occupational and speech therapies (PT/OT/ST) to align with recent CMS guideline updates.
New and updated billing policies
We’ve posted several new and updated billing policies, which align to industry standards, to the Provider Manual.
2025 commercial fee schedules are available online
2025 commercial fee schedules are available online
Understanding disallow code OX6
It’s important to us that you understand the way your claims are handled – including what the various codes that may appear on your remittance advice mean. One claim adjustment code we get a lot of questions about is OX6.
New and updated billing policies are now available
We’ve posted several new and updated billing policies, which align to industry standards, to the Provider Manual.
Resolving some vaccine codes denying incorrectly
We're correcting two issues with vaccine claims denying when they shouldn't.
Provider-based billing policy went into effect June 1
Our provider-based billing policy went into effect June 1.
Understanding why a claim denied
We've created a new resource to help you understand exactly why a claim may have denied and be able to take any appropriate next steps.
New or corrected claims requirement for retro authorizations
Starting Dec. 9, submit new or corrected claims when you get a retroactive authorization after a claim denial.