Project BRAVO Phase II – Implementation Check-In
The Virginia Department of Medical Assistance Services (DMAS) implemented seven (7) new behavioral health services and billing codes, which became effective on December 1, 2021.
They are as follows:
- Multi-systemic Therapy (MST)
- Functional Family Therapy (FFT)
- Mobile Crisis Response
- Community Stabilization
- 23-Hour Crisis Stabilization
- Residential Crisis Stabilization Unit (RCSU)
- Applied Behavior Analysis (ABA)
You are also encouraged to visit the DMAS Behavioral Health Enhancements site for the complete descriptions and detailed licensing requirements.
As a reminder, since implementation of Phase II we have noted that the most common claims denials have been D85 — not a contracted service; D19 — invalid modifier code and D95 — provider billing error. In response, we have developed the following recommendations that, when applied, will likely reduce denials moving forward.
- Billing with the modifier code HN when the rendering provider is a Licensed Assistant Behavioral Analyst (LABA) and can be billed under the Group (type II) NPI or the LABA's Individual NPI.
- Billing with the modifier HO indicates a Licensed Behavioral Analyst (LBA) provided the service and can be billed under the Group (Type II) NPI or the LBA's individual NPI.
- Claims submitted without a modifier indicates services were provided by a Registered/Unlicensed Behavioral Technician (RBT/UBT) — Optima Health does not credential RBT/UBT. Services must be billed with the Group (Type II) NPI.
- Billing with the modifier TF indicates a Licensed Mental Health Provider (LMHP) provided the service and can be billed under the LMHP's individual NPI or under the group type II NPI.
- Providers billing under their Group (Type II) NPI must have submitted an organizational application. If you are not certain please contact your network educator at (877) 865-9075, Option 2 with your group NPI to see if your group is set up as an Organizational Provider.
- Review the resources within the Project BRAVO Toolkit.
Finally, please note that your network educator may contact you to consult about claims denial trends we have identified for you. You may also contact your network educator by calling (877) 865-9075, Option 2 if you require assistance. As always, Optima Health thanks you for your partnership in improving heath every day.