Mental Health Medical Billing Workshop
Questions and Answers from Wellmark
All Payer Questions
Q: How long does a therapist have to have their license to be on your panel?
A: A licensed therapist can become part of Wellmark’s panel right away. There is no minimal
amount of experience or waiting period.
Q: Could the payer ID and address to submit mental health claims be listed on the card when
it is different than the payer ID number and address that is on the card for medical? Could
mental health co‐pays be listed on the patients’ cards when different than medical?
A: Blue Cross Blue Shield Association guidelines limit the space available for local plan
information. Space is tight on the card, both front and back. You can access the Wellmark
website for specific benefit information.
Q: Once Cobra payments are made by patients, couldn’t denied claims be automatically
A: Once membership updates are made, a report is generated to adjust the affected claims.
Q: Does your company require pre‐authorizations and what is the procedure? Could
authorizations be made for a service (example: medication management) versus to a specific
provider so that providers can cover for each other under one authorization?
A: Although Wellmark no longer requires precertification/notification for behavioral
health/chemical dependency services for the majority of our benefit plans, the Federal
Employee Program (FEP) and some employer groups have chosen to keep
precertification/notification requirement in place.
Q: What is your policy for credentialing MD‐PhD‐LISW‐PA‐NP‐LMHC? Could an exception be
made to accept a provider regardless that the maximum number is already practicing within
that area, especially when that new provider joins a facility where all the providers in that
facility are credentialed?
A: All providers are eligible to be credentialed and contract with Wellmark. We have no
maximum number policy.
Q: What is your policy for recouping payments? Warning/advance notice? Is there a chance to
send a check instead of getting short a payment?
A: Auto recoupment is Wellmark’s standard policy since November 1, 2007. We also allow you
to return funds within 30 days to avoid auto recoupment. You can check your Accounts
Receivables (A/R’s) on our website.
Q: When is it necessary for us to call customer service to check on payment?
A: You may call Provider Service if you have not received notice after 30 days, or you can view
all claim details on our website 24 hours a day with Blue Connection tools. This is a free service,
available to all contracting providers.
Q: What is your timeframe for payment after claim is received?
A: Wellmark pays clean claims within 30 days. This means that all necessary information has
been submitted on the claim.
Q: What is your policy and procedure to re‐negotiate reimbursement amounts? Some
companies automatically increase their reimbursement rates every year. How is that
A: Wellmark does not negotiate payment rates with individual providers or individual provider
groups. Wellmark performs an annual fee schedule review and update effective July 1 of each
Q: What impact does terminating a provider’s contract with an insurance company have on
the insurance company and their members due to the shortage of psychiatrists? And discuss
the impact this would have with the other facilities in the area and with employers switching
to another insurance company.
A: Wellmark recognizes it is in our customer’s best interest to have reasonable access to the
care they require. We are constantly working to provide networks that meet customer cost,
quality, and access goals.
Q: Why do we get a separate check for every claim? One check and one EOB with all claims
listed on it (ex: Wellmark)? Smaller companies pay bank fees by the number of checks
deposited each month.
A: This is not Wellmark’s policy. You will usually receive all claims finalized the week before in
Q: When calling some insurance companies, we enter/speak provider, patient and claim
information per the directions of a recording – the recording never gives us our answer, so we
get transferred to a person who asks for the exact same information again, and sometimes
transfers our calls so we start all over again. What happens to the information we already
provided? Couldn’t we just re‐verify the patient’s name and DOB?
A: This is not a Wellmark issue. We have Interactive Voice Response (IVR) which pulls
information for the Customer/Provider Rep. You should not have to repeat any information.
Q: What is the easiest way to verify insurance benefits?
A: It is easiest to use the Wellmark website. It is available to anyone with access to the Internet
and is 24/7.
Q: How can I get a list of providers you show as active? Do you limit your provider panels in
A: You can get a current listing on our website. You can search by product name, provider
name, specialty, or locality.
Q: Please clarify if we should use 90801 for hospital admit and any consults and not 99 codes.
A: It is always preferable to use a specific code rather than one that ends in 99. Each CPT code
has a narrative description. 90801 states specifically that it is a “psychiatric diagnostic interview
examination.” CPT further says that it “can be used for inpatient or outpatient services and
includes a history, mental status, and a disposition. It may include communication with family
or other sources, ordering and medical interpretation of laboratory or other medical diagnostic
studies. In certain circumstances other informants will be seen in lieu of the patient.”
Q: We never know whether a payer allows (and pays for) a client/patient to be seen at our
clinic twice in one day. This second visit would be for a different provider, different procedure
code, and a different claim form. In the past we have been scheduling our clients to be seen
for example: by a therapist and a medication management clinician on different days to avoid
non‐payment of one of the visits. Could you please inform us as to how we can know for sure
or if all payers do allow for two visits within the same day. We are located in a rural area and
with the price of gas, it has come to be a terrible inconvenience and burden on our clients and
your insurers. (When calling UBH on a certain client, I was informed they would NOT pay for
the two visits within the same day even when explained it was with two different clinicians.)
A: Wellmark will pay for a med check and psychotherapy on the same day, as long as services
are done by two separate staff members and both are billing with their own provider/NPI
Wellmark Specific Questions
Q: We are quoted mental health benefits for BCBS of Georgia and when we bill we are denied
“no benefits payable” and we get run around on why claim did not pay with no resolution.
A: We will need the specific claim/contract information in order to address this issue. Please
provide at the break‐out session.
Q: Can an MD and a therapist see a patient the same day? If yes, how should the claim be
coded so one of the claims will not be denied?
A: You can bill and be paid for both services as long as each provider has their own billing
number and is credentialed with Wellmark. You will not be paid for both services if one of the
providers is a mid‐level and is billing with the MD’s provider/NPI number.
Q: If we are set up with a CMHC provider status, can we bill with place of service “11” or do
we need to use “53?” Is there a difference in rate?
A: You will bill this situation on the CMS‐1500 using place of service “53.”