Category Archives: County carve out

Medi-Cal and Psychiatry (Tip: It’s a Mess)

If your psychiatrist is contracted with Medi-Cal, you are probably beating your head against your desk in frustration at this very moment. I know I am. This post will attempt to make your life easier and save you the headache when it comes to billing for your Medi-Cal patients.

First things first. Medi-Cal does not cover psych services directly EXECPT when the patient is mentally retarded. That means your claim needs to have an ICD9 code between  317 – 319. If your patient is mentally retarded, you can send a claim directly to Medi-Cal and they will pay you. But only with 2012 codes or office visit codes. Medi-Cal hasn’t updated to the new 2013 codes for psychiatrists.

Treatment for any other diagnosis carves out to the county. Please note, this is NOT the county the patient currently resides in. The claim goes to the county of origin. Which you can find on your online Medi-Cal eligibility verification sheet. If you do not have online access to Medi-Cal eligibility, I suggest you stop reading this post and go sign up. Remember to come back though. The explanation gets more convoluted. Once you’ve determined where the claim should be filed, please also make sure your provider is properly contracted with the individual county plans. If she is a Medi-Cal provider but her Los Angeles County Mental Health contract has lapsed because the office manager did not do the credentialing in a timely manner, your claims will not get paid. For example.

If a patient walks in with a Medi-Cal based HMO such as IEHP or Blue Cross, the claim also goes to the county. However, if the plan is based on the Healthy Families program or a DualChoice program with Medicare and Medi-Cal combined, you would need to call the health plan to determine where to send the claim. And I am sorry, but there is no quick and easy guide for that; the claims address and financial responsibility for mental health depends on the individual plan.

For mentally retarded patients with Medi-Cal based HMOs, the claims STILL go straight to MC. Even if your office manager gets an authorization from the health plan, send your claim directly to Medi-Cal. I have attached a small flow chart  to help you get your claim to the correct place along with a list of county mental health carve outs. Unfortunately, I can only include the carve outs I have worked with.

So, any of you out there with carve out information not on this list, please shoot me a quick email at newgenerationbilling@gmail.com or comment on this post so I can add it. I will add the flow chart and the county carve out list to the links and tools page. Remember, if you are going to bookmark anything, the links and tools page would be the smart way to go.

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Filed under Authorizations, Billing, Claims, County carve out, Doctor's Office, Medi-Cal, Medical Billing, Psych