Blue Cross Blue Shield of Michigan (BCBSM) & Blue Care Network (BCN) direct reimbursement available for Licensed Professional Counselors

After years of collaborative efforts, Licensed Professional Counselors (LPCs) are now eligible to begin the BCBSM and BCN paneling process beginning October 1, 2015 and reimbursement for services rendered will begin January 1, 2016.

LPCs will have the opportunity to participate in Blue Cross Blue Shield of Michigan’s Traditional, TRUST (PPO) and Mental Health and Substance Abuse Managed Care networks (BCN). Participating LPCs will receive direct reimbursement for covered mental health services that fall within their scope of practice/licensure (which includes any service an LPC has formally/ethically received training, i.e. see MCA/MMHCA scope of practice document).

Covered mental health services will be reimbursed at 80 percent of the Traditional, TRUST and MHSAMC doctoral level practitioner fee schedule, less any member deductibles and copayments. Additional provisions for expanded coverage continue and will be made available for dissemination as they become active, i.e. reimbursement parity for doctoral level LPCs, etc.

Note: Not all BCBSM plans (i.e. Self-Funded Plans) will cover LPC services or services billed directly by an LPC. However, services may still be billed on an “incident to” basis for both LPCs and LLPCs until these plans adopt coverage for LPCs. As additional Self-Funded Plans become eligible for contract renewal, it is expected they too will adopt LPCs as covered providers under their respective plans. To find out if a subscriber has coverage, check web-DENIS for member benefits and eligibility or call PARS at 1-800-344-8525. Also, if an LPC registers as a ‘nonparticipating’ provider for Traditional BCBSM plans, payments for covered services will be sent directly to the member.

Beginning October 1, 2015, LPCs can find the Traditional, TRUST and MHSAMC practitioner agreements and enrollment forms on bcbsm.com. To find enrollment information, click on Providers, and then on Join the Blues Network and Enrollment and Changes. Specific qualification requirements are identified within each agreement. Qualified LPCs may apply for a BCBSM provider identification number by completing the enrollment applications available on this site.

Beginning February 1, 2016, LPCs (or any provider type) will not be able to enroll in BCN until the next enrollment period which is October 1, 2016 through January 31, 2017.

All interested LPCs must be registered with a National Provider Identification (NPI) number, as well as a Council for Affordable Quality Healthcare (CAQH) number. Additional information on how to obtain these numbers are available online to members of Michigan Mental Health Counselors Association (MMHCA).

For more information, contact Provider Inquiry, your BCBSM provider consultant, or MMHCA.

Thank you to all that participated in this awaited accomplishment.

Donald E. Deering, Ph.D., LPC, NCC

President, Michigan Mental Health Counselors Association

2 Comments

  1. Do you have documentation from BCBS showing the allowance of Incident To billing for LLPC’s? I am unable to locate it but have located that LLPC’s are not able to bill under a supervisor for BCN insurance for any solo or group practice but only agencies or accredited substance abuse facilities.

    Reply
    • Hi Melissa, Contact BCBS Provider Consultant Geonisha Washington at gwashington@bcbsm.com
      and she can give you documentation!

      Reply

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