Name of Manual - Blue Cross and Blue Shield of Minnesota

Extended Care and
Halfway House Room
and Board (Medicaid
Government Programs
Only) (continued)
Partial Psychiatric
Billing
Admission Notification
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual 06/19/12
Coding Policies and Guidelines (Behavioral Health)
For Blue Plus members in the affected groups, please notify Blue
Plus of the member’s extended care or halfway house services by
faxing a copy of the following forms to (651) 662-0718:
Chemical Dependency Notification of Residential Admission
Form
Rule 25 Assessment and Placement Summary
The Chemical Dependency Notification of Residential Admission
Form is available at bluecrossmn.com. Blue Plus will notify you
that the information has been received.
Discharge Notification
Please notify Blue Plus of a discharge from extended care or
halfway house services by calling (651) 662-5270 or
1-800-528-0934; prompts will direct you to the correct option to
leave the discharge date. You may also fax discharge information
to (651) 662-0718. When reporting a discharge, please provide the
following information:
Member name and ID #
Blue Plus case number provided by Blue Plus
Provider name, contact name and contact phone number
Discharge date
Partial psych services must be billed as an outpatient service under
revenue codes 0912 or 0913. Detailed billing requirements are
listed below.
If your psychiatric unit is Medicare-certified, the following
instructions apply:
Bill using your NPI with the appropriate taxonomy code (partial
psych)
If the patient is not a Medicare member, submit claims using
TOB 013X (Hospital Outpatient) with revenue codes 0912-
0913 and HCPCS code H0035. For a child/adolescent program,
use H0035 with the HA modifier.
0912 – Behavioral health treatments/services – partial
hospitalization – less intensive
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