Since September 1, 2011, the settings in which Screening, Brief Intervention and Referral to Treatment (SBIRT) services have expanded to include primary care settings and also reimbursement for primary care physicians and physician extenders (e.g., physician assistants and nurse practitioners and midwives) who conduct SBIRT for Medicaid managed care and Family Health Plus (FHPlus) members 10 years and older.
SBIRT is a screening and referral program designed to identify individuals at risk for substance use issues and provide early intervention to prevent the development of serious substance abuse. Members whose SBIRT screening identifies them as needing treatment from a substance abuse professional should be referred to an Emblem Behavioral Health Services practitioner. Receipt of SBIRT services does not preclude Medicaid managed care and FHPlus members from self-referring for one chemical dependence assessment in any calendar year.
Credentialing SBIRT Practitioners
To render SBIRT services under this benefit expansion, you must be a PCP or PCP extender and certified by the American Society of Addiction Medicine (ASAM), the American Board of Ambulatory Medicine (ABAM), the American Academy of Addiction Psychiatry (AAAP) or the American Academy Osteopathic Association (AOA), or have completed an Office of Alcoholism and Substance Abuse Services (OASAS)-approved SBIRT training of at least four hours. Learn more about available OASAS resources, screening tools and training.
EmblemHealth will credential practitioners as having the above certification or training. To be credentialed for this expertise, practitioners must:
EmblemHealth practitioners may forward requests and proof of certification or training by fax to 1-212-510-5268. The Credentialing department will process the practitioner for Credentialing Committee approval.
Emblem Behavioral Health Services practitioners participating with ValueOptions may forward requests for credentialing and proof of certification or training to ValueOptions for approval by fax to 1-866-612-7784. Practitioners not participating with ValueOptions must submit a credentialing application in addition to proof of SBIRT certification or training.
Note that claims for SBIRT services will be denied if the service provider is not credentialed for SBIRT services.
SBIRT services may be billed using the following HCPCS procedure and diagnosis codes:
SBIRT services are not subject to the FHPlus calendar-year benefit limit for behavioral health services or FHPlus copayments. New York State Department of Health regulations prohibit managed-care plans from prior approving SBIRT services. As a result, we cannot advise practitioners whether the member has exceeded the limit prior to service delivery. However, EmblemHealth will not pay claims that exceed the member's benefit limits.
EmblemHealth will reimburse practitioners for SBIRT services rendered to Medicaid members without regard to the SSI status of the member or the nature of the visit. SBIRT services will be reimbursed in accordance with your Provider Agreement.
For questions about SBIRT services, contact us at 1-866-447-9717, option 5. Or you may use the Message Center by signing in to our Web site. For behavioral health questions related to SBIRT services, please contact ValueOptions at 1-800-235-3149.
|GHI and HIP are EmblemHealth companies. ©2013 EmblemHealth. All Rights Reserved. Last Updated 3-28-2012. Effective September 23, 2010, federal health reform may require changes to your coverage, depending on your plan. Get more information.|