- Quality Review Process
- Screening Tools
- Case Management Resources
- Utilization Management Information
- Affirmative Statement About Incentives
- Credentialing Information
- Clinical Practice Guidelines
- Medical Necessity Criteria
- Provider Network
Does BHPI have a medical person on staff?
BHPI employs a number of licensed clinicians and health care professionals. Our Medical Director is a contracted position rather than an employed position.
Will providers be made aware of any restrictions prior to beginning the credentialing process?
At this point there are no restrictions that would need to be identified prior to a provider undergoing the credentialing process.
What is the process timeline until start date?
We are aggressively marketing our network to Health Plans operating in the area. We know there is an expanded need since the pilot project for Wayne County Dually Eligible (Medicare and Medicaid) Population became active in July 2014.
Will BHPI use CAQH during the credentialing process?
We are investigating the possibility at this time.
What is the fee schedule and will it be tiered?
The fee schedule will be based upon the product design. Different benefit program types may have differing fee schedules.
Will there be an authorization process?
Some services will require pre-authorization.
What if I don’t take Medicaid or Medicare?
Participation with Medicare and/or Medicaid is not a requirement to become a provider; however, non-participants may experience less opportunity for patient referrals.
Can I be a provider in other networks and still be a provider with BHPI?
Certainly, we encourage providers to participate with other organizations in order to maintain a complete practice schedule.
Will the providers get paid for psychological testing (ADHD and Anxiety Test)?
Yes, assuming it is a covered benefit under the patient’s benefit plan.
Can a provider choose to use a sliding scale?
Providers are always able to utilize whatever fee structure they deem appropriate for their practice. The reimbursement rates will be fixed and some programs may preclude “balance billing” above the stated co-payment level.