Advocacy

Blue Cross Blue Shield Reimbursement

Update as of September 14, 2009

NASW-Michigan continues to be in regular communication with Blue Cross Blue Shield.  We have been informed that the strategic business plan has been completed and the next step is implementation.  It is our understanding that it will be another 6 months or more until everything is up and running.  Please feel free to call the NASW-Michigan office if you have questions rather then contacting the Blue Cross offices.

A Little History

BCBSM has agreed to cover services provided by clinical licensed master’s social workers (LMSWs) by adding them to its Traditional and TRUST (The Responsible Use System of Treatment) networks. TRUST is the primary PPO network and BCBSM’s largest provider network, which services members in Blue Preferred, Community Blue, MIChild and the autos’ managed care products. Professional providers and facilities contracted for the TRUST network number more than 30,000.  Further, BCBSM has agreed to eliminate its requirements that clinical LMSWs be supervised and/or obtain the countersignature of another licensed health professional in order to be reimbursed for services.  Under these direct billing provisions, clinical LMSWs will have their own PIN/NPI numbers and will be reimbursed at the BCBSM approved rate for services rendered by a master’s level practitioner.
  
Clinical LMSWs will still be allowed to be reimbursed indirectly for services provided in collaboration with an M.D., D.O. or fully licensed psychologist. In those cases, the bill should be submitted using the supervising practitioner’s PIN/NPI and reimbursement would be at the BCBSM approved rate for services rendered by a physician or PhD, whichever is applicable.  In order to receive reimbursement indirectly the physician or psychologist must have direct contact with the patient or client and actively collaborate with the clinical LMSW on patient/client care.

It will take at least a year for BCBSM to fully implement all the necessary changes to begin reimbursement procedures for LMSW services under these additional plans.  We will continue to update Chapter members through Connections and the Chapter website as additional information is made available. 

If you have any questions, please contact the Chapter office rather than BCBSM.