Skip to main content

Reminder: Proper Billing for Behavioral Health Providers

Date:
July 25, 2022

To: Behavioral Health Providers

As a reminder, behavioral health providers must include the correct taxonomy and performing provider information (when applicable) on 837P and CMS 1500 claims for Legacy and Highmark system patients. Doing so ensures your claims are processed correctly.

Individual Credentialed Providers

Providers who are individually credentialed with Highmark Blue Shield of Northeastern New York must include the NPI number and taxonomy of the billing provider in the Billing Provider Loop on the 837P or in Box 33a (NPI) and Box 33b (Taxonomy, must include ‘ZZ’ qualifier) on the CMS 1500 claim form.

You must use the taxonomy code that corresponds with the specialty type of the billing provider group:

  •   Same-specialty groups (Example: all Clinical Social Workers) must use taxonomy code 1041C0700X
  • Multispecialty groups must use taxonomy code 193200000X

Additionally, individual credentialed providers must also include the NPI number AND taxonomy code of the performing provider in the Performing/Rendering Provider Loop on the 837P or Line 24J on the CMS 1500 claim form. The following provider types should bill in this manner:

  •  Certified Social Worker
  • Licensed Mental Health Counselors (LMHC) credentialed for Commercial (non-Medicare Advantage) plans ONLY
  • Psychiatrists (MD or DO)
  • Psychologists
  • Independent Psychiatric Nurse Practitioners

Providers Covered Under a Billable Group

Providers who are covered under a billable group (not individually credentialed with Highmark BSNENY) must include the NPI number of the billing provider group and taxonomy code. This information should be in the Billing Provider Loop on the 837P or in Box 33a (NPI) and Box 33b (Taxonomy, must include ‘ZZ’ qualifier) on the CMS 1500 claim form.

  •  Billable groups must use taxonomy code 101YM0800X

Please note: The Rendering Provider Loop on the 837P or Line 24J on the CMS 1500 claim form must remain BLANK. You do not need to include an NPI number or taxonomy code in this loop/field.

Additional information regarding CMS1500 fields can be found at www.nucc.org.

 For the most updated claims and billing information related to our affiliation with Highmark, please review our provider FAQs at bsneny.com/workingtogether.

Recent Articles

  • Provider Resource Center to Replace Legacy Provider Website on February 1, 2023
    Beginning on February 1, 2023, we will be redirecting those visiting our legacy provider website (bsneny.com/provider) to the Highmark Provider Resource Center (PRC). The timing of this transition will occur after all Highmark BSNENY patients have been moved onto Highmark’s system in January 2023. In this article, you can learn more about this change and how to access important resources on the PRC.
  • New Phone Self-Service Tools
    To help reduce Provider Service call wait times, we’ve introduced new self-service phone tools. When you call Provider Service at 1-800-444-4552 or 1-800-950-0051, you will hear new voice prompts to help you access patient information, including claims status, eligibility, and benefits without speaking to a representative.
  • Virtual CME Opportunities
    As you consider how to complete required Continuing Medical Education (CME) before the end of the year, we are happy to offer some new CME opportunities. You can earn up to 6 CME credits online at no cost through Highmark’s Population Health University and Coding and Quality Knowledge College. In this article, you can register for online modules, as well as an October webinar.
  • 2023 Vatica Incentive Payment Changes
    Starting January 1, 2023, incentive payments for Vatica Annual Wellness Visits (AWV) will be paid directly from Vatica Health. Payments will be made monthly. This change creates a more streamlined process and eliminates the possibility of incentive payment discrepancies. Here, you can access updated billing grids and view coding guidance.
  • Utilization Management: Coverage and Denial Processes
    Understanding coverage and denial decisions and knowing the right steps to take after an authorization is denied will help your patient get the right care at the right time. This article provides further guidance on the appeal process after an authorization denial.

Working with Us

Additional Resources

We want to hear from you! Have a topic request for the next Blue Bulletin? Email us

Stay in Touch! Sign up to receive emails for provider news and information