Billing Behavioral Health Medicaid Services Under Managed Care
BH Rate Updates and Protections
Adult BH HCBS Rate Increases* (January 2018)
Minimum Wage and Cost of Living Adjustment Increase (1 November 2017)
Quick Reference Guide: Protections for BH Government Rates
Required MCO Payment of APGs and Government Rates (2 November 2017)
Contracts for ambulatory behavioral health services that state Managed Care Organizations (MCOs) may pay “the lessor of APGs or charges” is in violation of law for both APGs or other forms of government rates. DOH is directing MCOs to ensure reimbursement to providers for ambulatory behavioral health services is at the APG rate for behavioral health clinic services or the published government rate for other ambulatory behavioral health services.
Billing Behavioral Health Medicaid Services Under Managed Care
BH Billing and Coding Manual for NYS HARP/Mainstream MMC* (May 18, 2017)
Coding Taxonomy* (March 4, 2016) – This file provides the required coding construct for billing the OMH/OASAS government rates services.
Upstate HARP BH HCBS Fee Schedule – Updated 3-1-2018
Downstate HARP BH HCBS Fee Schedule – Updated 3-1-2018
Implementation Billing Guidance
Adult BH HCBS Staff Transportation Billing Guidance
Claiming Guidance for Clinics, Opioid Treatment (OTP), PROS and ACT for claims that utilize the OASAS or OMH unlicensed practitioner ID
Comprehensive Psychiatric Emergency Programs (CPEP) and Extended Observation Beds (EOBs): Submitting Billing (September 29, 2015)
* If you are having accessibility issues with the previous documents, please contact Office of Diversity Management, or call (518) 473-4144.
All questions or complaints regarding Behavioral Health Medicaid Managed Care should be submitted to the OMH Division of Managed Care using the OMH MC Question/Complaint Form. This ensures all questions or complaints submitted can be reviewed and responded to by appropriate staff within OMH and/or the Department of Health.