Billing Review Instructions for BHP Services

Billing review tips for BHP services 

Log into and select from the menu: Invoice Clients and Insurance.

Before you begin reviewing click on “Unselect”.  This will un-check all boxes and prevent you from inadvertently sending the wrong claims.

Click on the lock to review the note and the folder to review the corresponding bill. The red x will delete the session bill from the system.

I recommend you begin with the session note:

Review the note to ensure that all boxes are filled out as they follow the outline of required Medicaid documentation for Goal, Intervention, Response, and Plan.

Check the date and time of the session against the date and time of the note to verify the note was documented within 48 hours of the session. Click here for a time conversion chart. 

Verify the minutes are consistent with the times listed.  This will be checked with the minutes and codes used on the corresponding session bill.

Observe the type of service checked as this will also need to correspond with the session bill. Click here for a list of CPT codes and their times.

When checking for attendance, remember that the client must be present for all or part of a therapy session.  Collateral 90887 and Family Therapy without the client 90846 are exceptions.

If an immediate risk is indicated, verify that a safety plan was implemented.

Up to 3 problems and goals can be entered and should correspond with the current treatment plan.

The Measurable Outcomes is updated each session to show progress in goal attainment.  Look for changes in frequency and intensity.

The goal for today’s session is preferably the client’s stated goal for the session.

The intervention section should document the theory of treatment, modality, techniques or actions of the provider.  Interventions must be consistent with the type of service indicated such as CBT for psychotherapy.

The response section should document the client’s immediate response to the intervention provided during the session as well as follow up on previous session interventions.

Does the information provided reflect the time billed.  In other words, does it explain why the session may have lasted three hours instead of one hour.

In the Plan section ask the provider to document the planned frequency for therapy such as individual therapy,1 x per week. This should also be consistent with the treatment plan and explain any changes from the plan.

The next appointment time is meant to be a specific day and time.  If the session is cancelled or rescheduled and addendum should be added by the provider to document the new appointment time.

If the note meets your approval, click on Add Note Addendum located at the bottom of the page. In the drop down box, select Supervisor Approval.  Click Save and this will add your supervisor signature to the note.

Next review the corresponding Client Session Bill:

Return to the Invoice Clients and Insurance Screen off the main menu

Select the Manila Envelope of the session date you are reviewing. This will open up to the details of the claim.

Billing Code: Verify that the billing code, times and units are consistent with the service and times indicated on the note.  Again click here to see the chart explaining  CPT codes and service minutes. 

Location Type: Use 12 Home for services provided in the home and school.  You may use 11-Office for services provided in the clinician’s office.  Click here for more info.

Office Location: Always use Main Office

Bill To: Always use Automatic (let the system decide)

Paid at session: This is generally used by clinicians who are receiving payment from a client for a commercial plan or private pay agreement.  Ck Nbr is for a check number or a verification number on a credit card payment. It will remain empty if no payment is received.

Bill Code Modifiers: Click here to verify the provider is using the correct modifier for the licensing type and the client insurance plan. Commercial plans do not require modifiers.

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Prior Authorization Number:  This should be left blank unless the insurance plan requires a prior authorization number.  If the provider has correctly entered the authorization number in the client set up the number will appear in red at the top of the client session bill.

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Insurance Company Overrides:  This is important for claims that have a secondary insurance company with Medicaid or a Medicaid funded MCO.  The provider must enter the requested data. If this is done correctly with the first session bill it will automatically populate for additional session bills.   Click here for instructions.

Comments Box: If the session bill does not meet your approval, type in the missing or incorrect data in this box.  The provider can then access your notes and see the issue needing correction.

Client File notes- Review for the due dates for releases and treatment plans or other issues.

CAFAS and Treatment Plans:  To verify a CAFAS assessment and treatment plan you must sign into the CAFAS system and review the client work.  The system gives the completion date of the assessment and due date for the next assessment. Please verify that the provider electronically signed the assessment.  You must open the treatment plan to verify its existence and completion.  Once you are satisfied with the quality, then edit the due date in the Client File Notes.  The edit is done in the Client Set Up  off the main menu.  Clients without a CAFAS will have a Treatment Plan entered in to a note on MCP.

Treatment Plan Documentation:  State regulations require the provider to document the client’s participation and response to the plan in a signed note.  Do not approve a treatment plan until you verify the following:

  • The provider has written a note or an addendum to the service team meeting note in order to document the following Medicaid requirements:
  • The client and/ or guardian :
    • participated in the development of the treatment plan
    • reviewed or received the written plan 
    • agreed to the plan ( or made amendments)

Discharge Plan: State regulations require that a copy of the discharge plan be sent to the follow-up provider with in 10 days of the discharge.  This would include the primary care physician.  We now have a Discharge Summary form in MCP.  Verify that this form is complete and that an addendum has been added to document the sending of the form.  Please be aware that this documentation does not have a corresponding billable code.  You can find notes with out corresponding bills by checking the date drop box on a note or by running a report.

Run an Audit Report each week to check that you have signed off on all notes including notes that did not have a corresponding bill.  Click here for instructions.