Become a Behavioral Health Systems Provider
Behavioral Health Systems, Inc., is privately owned company headquartered in Birmingham, Alabama. Formed in 1989, the company has experienced consistent, profitable growth throughout its history. We are not among the biggest companies in the industry, but we are growing rapidly. We use our smaller size as an opportunity for friendly, personalized service to our customers, providers, and members. Our provider network is national in scope and we are currently recruiting new providers throughout the United States.
BHS values are a match for the values of professional behavioral healthcare specialists, providing high quality behavioral health and substance abuse services at an affordable cost. We know that providers are the core and heart of our work. We understand that our job is to make your job easier. We listen to and learn from our providers so that together we can serve our mutual clients.
The Basic Criteria
All providers must meet the following basic criteria:
We encourage you to contact us for an application packet to become a participating provider in our network. As part of the application process, we will need verification of the following:
= Current state licensure or certification
= Current professional/general liability insurance in amounts no less than $1 million/$3 million
= Vitae, clinical degrees and credentials
= Continuing education at no less than the minimum level required by your state licensure, if qualifying as a specialist in either child/adolescent or substance abuse
= DEA Certificate (if applicable)
You may contact us:
= Online Application
= By email at providerrelations@behavioralhealthsystems.com
= By telephone at 1-800-245-1150
Application Process
After we receive your application, Behavioral Health Systems must verify your license, malpractice insurance, educational degrees, and hospital privileges, (physicians). We query the National Practitioner Data Bank for malpractice settlements, all license suspensions, and the Office of Inspector General for Medicare sanctions. The final step is review by BHS's Credentialing Committee. The entire process could take up to 120 days. You will be notified via regular mail once the process is complete.
Recredentialing
We recredential our participating providers every two years. At that time, we will send you a brief questionnaire and a list of necessary updates. In the interim, please send copies of your current license and liability insurance as they renew. Direct all documents to the attention of Provider Relations, fax: 205-879-1178 or
Behavioral Health Systems
P.O. Box 830724
Birmingham, AL 35283-0724
Recredentialing Application
Changes to Provider Information
We can't refer patients to you if we can't find you! Please notify of us of any changes to your:
= Practice location or mailing address
= Telephone and/or fax numbers
= Tax identification numbers
Group affiliations
BHS adheres to NCQA and URAC guidelines for provider credentialing.
Precertification: There are 3 steps to the BHS precertification process.
1. The covered member calls BHS. This allows us to:
= Perform our necessary intake process
= Verify the patient's eligibility and plan type
= Explain the benefit process
We can't do this if you make the initial call, so please have the patient call BHS directly if he or she calls you first.
2. BHS performs intake process and confirms eligibility.
3. BHS calls you to schedule appointment and confirm co-payment.
Emergencies
In an emergency, BHS covered members are directed to:
= First seek the care they need
= Then call BHS as soon as possible
If a member in crisis calls you or presents to your office, when possible call the BHS Care Coordinator to discuss:
= The patient's symptoms
= Your recommended treatment before referring the patient to the emergency room
A BHS Care Coordinator is available 24 hours a day.
Authorization Procedures
BHS evaluates each treatment plan on the basis of:
= Acuity and medical necessity
= Projected outcome and length of treatment
= Appropriateness/effectiveness of treatment protocols
Each case is individually evaluated. There are no automatic authorizations for treatment.
Please take the following steps when a referral for assessment is made to you.
1. Contact the referring BHS Care Coordinator after the initial visit.
= Give us your preliminary report and recommendations
= If medically necessary, we may be able to authorize an additional visit while awaiting your clinical data.
2. Forward the clinical information to BHS as soon as possible. This includes the following forms:
= Clinical Assessment
= Recommended Treatment Plan
= Patient Information/Release form
3. Once we have received and reviewed the clinical data, we will send you written notification regarding the authorization of coverage for extended treatment.
4. If we ask you to assess a hospitalized patient:
= Call the Care Coordinator following the assessment to give your initial report
= Mail or fax us your Clinical Assessment and Recommended Treatment Plan
= Do not discuss your recommendations with the hospital staff. All approval/non-approval certifications are issued by BHS directly to the hospital
Continuing Care Certification
When you feel the patient requires continued therapy or supplementary services beyond what has been approved:
= Forward an updated Recommended Treatment Plan to BHS to show the status of the patient and additional treatment recommended
= We will send you written notification regarding authorization of the additional treatment
Claims Processing
You can obtain prompt payment for the services you render by following these suggestions: Verify benefits, eligibility and deductibles by calling the number on the back of your patient’s benefits card. If no number is available, please call 1-800-245-1150 for assistance. Submit claims for approved services on CMS (formerly HCFA) 1500 forms for outpatient billing and UB/92 forms for Inpatient billing.
= All claims must be submitted to BHS within 90 days of the date of service
= The patient may not be billed for services we deny due to late submission
= Enclose Clinical Progress Reports with claims
= BHS "batch" processes claims once a month
= Claims which we receive and process by the 25th day of the month will be paid on or about the 25th day of the next month
Send claims to:
Behavioral Health Systems
P.O. Box 830724
Birmingham, AL 35283-0724
Submit claims to BHS by the 25th of the month for timely turnaround processing. Please do not bill BHS members except for co-payments, and for non-covered services which are authorized in advance by the patient. Our Claims Department will assist you with any questions or concerns you may have regarding claims payment activity. If you have not received payment within a reasonable time, please call to check on the status of your claim. You may also contact Claims Department by email. If you wish to talk with someone by phone you may call 1-800-245-1150.
Claims Appeal
Behavioral Health Systems offers you the right to appeal any claims decision. Claims Appeals should be made no later than one year from the date you receive your claim decision. A request for appeal can be made through email or by sending a written request to the address shown below. In either case, be sure to indicate any additional information to support your appeal of the original claims determination. An expedited appeal process is available for emergency cases.
Vice President, Clinical Services
Behavioral Health Systems
P.O. Box 830724
Birmingham, AL 35283-0724
Patient Co-payment
It is important to collect the co-payment from the patient at the time of the visit.
= Each patient's co-payment may vary according to the benefit plan and the type of service you provide.
= Please confirm the co-payment amount with BHS at the time the referral is made.
Please do not bill the patient for services covered under the BHS plan.
BHS Clinical Policies
BHS has implemented policies designed to reinforce patient compliance with provider recommended treatment plans. These policies apply to patients suffering from serious mental illness (i.e., schizophrenia, bi-polar affective disorder, or major depression). The policies are intended to:
= Facilitate the achievement of a positive outcome for the patient
= Reduce the relapse rate caused by non-compliance
Compliance is assessed as:
= Adhering to prescribed medication regimen
= Keeping regularly scheduled follow-up appointments
= Participating in additional outpatient care as specified in the discharge treatment plan
Quality Management
Quality Management at Behavioral Health Systems encompasses issues affecting quality of care for our members, such as tracking and analysis of member complaint data and audits of provider treatment records to ensure adequate documentation, assessment and treatment planning practices. In addition, BHS's Quality Management department facilitates communication of, and compliance with, accrediting and regulatory guidelines. Finally, Quality Management at Behavioral Health Systems is research-focused, using data gleaned from Member Satisfaction Surveys and Outcomes, Record Audits and member complaints to study best practices and to maintain a focus on continuous quality improvement in the systems affecting care.
Member Complaints
Member complaints may be filed by telephone or in writing. Behavioral Health Systems acknowledges receipt of any written complaint, and notifies the member that the issue will be investigated. Written complaints about practitioners are investigated by BHS Provider Relations staff and reviewed with the BHS Medical Director. Data acquired through the tracking of member complaints is used for ongoing quality improvement at BHS. For questions about claims or claims status, contact claims@behavioralhealthsystems.com. For questions about credentialing requirements, applications or renewals, contact providerrelations@behavioralhealthsystems.com.
Frequently Asked Questions
How do I go about joining the Behavioral Health Systems network?
Simply click on the following link:
“Become a Member of the BHS Network"
How do I check the status of my application?
Contact Provider Relations by email at providerrelations@behavioralhealthsystems.com or call BHS’s Provider Relations Department at 1-800-245-1150.
What are the reasons Behavioral Health Systems could decide to terminate my participation in its network?
Common reasons for termination of a provider's network participation are:
= Failure to adhere to contractual requirements.
= Inability or unwillingness to comply with BHS administrative requirements for network participation, including failure to comply with requests of Care Coordinators or credentialing procedures.
BHS does not terminate a provider's participation on grounds that the provider:
= Advocated on behalf of a member.
= Filed a complaint against BHS.
= Appealed a decision of BHS.
= Requested a review or challenged a termination decision.
What are your fees and how do you arrive at them?
BHS fees are based on market rate conditions as determined by our surveys, and comments from providers, purchasers, and members.
How much paper work is there?
BHS recognizes that a provider's time is best spent seeing patients and not performing administrative duties. For that reason, BHS has streamlined its reporting requirements to meet minimum requirements for administration.
How many outpatient visits will you authorize at a time?
The number of sessions authorized varies according to the acuity of each patient's condition. Other factors affecting authorizations include the benefits available to the patient and his or her compliance with past treatment recommendations. Some plans offer only Employer Assistance Programs (EAP), while other integrate EAP services with behavioral healthcare and substance abuse programs typically offered as a carve-out from the health benefit plan.
How many lives do you have (especially in my area)?
Behavioral Health Systems is constantly growing its business nationally. Our growth rate is over 17% annually. If you are receiving a new application, there is a good chance that BHS has agreed to provide behavioral healthcare services for a company in your area and that we are developing the network in your area to meet those needs. If you want to know the extent of our business in your geographic area, call Provider Relations at 1-800-245-1150, or e-mail us at providerrelations@behavioralhealthsystems.com.
What are the benefits for a Behavioral Health Systems’ member?
Benefit structures vary from contract to contract, and members are often unsure of what their benefit entails. Benefits are designed by purchasers in collaboration with health care consultants. BHS is hired by the purchaser to administer its behavioral health care benefits. Our authorization letter provides you with some important information, and you can get additional information by calling BHS at 1-800-245-1150.
Why haven't I received any referrals lately?
In some situations, members are already seeing a specific provider. In this case, we do not attempt to "steer" the member to someone else. In other situations, our case managers may not know that you are available to accept referrals. Please feel free to contact our Provider Relations Department at 1-800-245-1150 and ask to speak to a supervisor to let them know of your interest and availability.
Where do I send claims?
Please return to the Provider Services page and click on the link entitled “Claims Processing” for information on claims payment processes and advice on how to insure that a claim is paid quickly.
