Behavioral Health Secure Transportation (BHST) Billing Manual

• Benefit Overview
• General Billing Information
• Eligible Providers
• Non-Emergent Medical Transportation (NEMT) Providers
• Payment for Covered Services
• Member Service Eligibility
• Prior Authorization
• Covered Benefits and Limitations
  • Covered Services
  • Exclusions
• Resources
  • Behavioral Health Secure Transport (BHST) Web Page
• BHST Billing Information
  • Claim Type
  • Diagnosis Codes
  • Dates of Services
  • Span Billing
  • Place of Service Codes
  • Procedure Codes and Rates
  • Trips over 250 Miles
  • Multiple Trips in a Single Day
  • Timely Filing
• Claim Example
• BHST Revision Log

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Benefit Overview

Behavioral Health Secure Transportation (BHST) is a benefit for all Health First Colorado (Colorado's Medicaid program) members who are experiencing a behavioral health crisis and require urgent transportation for behavioral health stabilization and treatment.

Providers must be enrolled as a Health First Colorado provider in order to:

• Provide BHST services to a Health First Colorado member
• Submit claims for payment to Health First Colorado

BHST Regulations can be found in 6 CCR 1011-4 and in individual county jurisdictions. Enrolled providers may only bill the Department of Health Care Policy & Financing (the Department) for services rendered according 6 CCR 1011-4, local county law, and approved Creation of the Medical Assistance Rule concerning the Secure Transport Benefit, Section 8.019.

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General Billing Information

Refer to the General Provider Information Manual located on the Billing Manuals web page under the General Provider Information drop-down menu for general billing information.

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Eligible Providers

To provide BHST services to Health First Colorado members and receive reimbursement, a provider must:

1. Obtain the appropriate licenses and permits:
   • Licensing and permitting of BHST services in Colorado are conducted by county governments. Contact the appropriate county commissioner's office for specific county BHST licensing and permitting requirements and/or verification of a valid license and permit. Visit the Secure Transport web page for a list of county contacts for BHST licensing and permitting.
2. Complete provider enrollment to become a Health First Colorado BHST provider. Visit the Provider Enrollment web page for enrollment information.
   • To be eligible to be reimbursed for Health First Colorado BHST claims, providers must enroll correctly prior to providing services. Below are the options for provider enrollment type who may bill for BHST claims:
     • Provider Type/Code: 97 - Behavioral Health Secure Transportation
       Specialty: Secure Transportation
       Specialty Code: 773
     • Provider Type/Code: 13 - Transportation (Emergency Medical Transportation)
       Specialty: Specialty: County Agency
       Specialty Code: 124
     • Provider Type/Code: 13 - Transportation (Emergency Medical Transportation)
       Specialty: Emergency
       Specialty Code: 324

The Department requires revalidation of enrollment every 5 years, or sooner if any licenses/permits require updating. If you find that any enrollment paperwork becomes outdated, update by completing a maintenance request.

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Non-Emergent Medical Transportation (NEMT) Providers

Providers must complete a separate enrollment application to be eligible to provide Non-Emergent Medical Transportation (NEMT) services.

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Payment for Covered Services

Regardless of whether Health First Colorado has actually reimbursed the provider, billing members for covered services is strictly prohibited. Balance billing is prohibited; if reimbursement is made, providers must accept this payment as payment in full. Refer to Program Rule 8.012. The provider may only bill the member for services not covered by Health First Colorado.

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Member Service Eligibility

A Health First Colorado member is eligible for Secure Transportation Services if the member is in a Behavioral Health Crisis. A Behavioral Health Crisis, which can include both mental health and substance use-related issues, may be established by one of the following professionals:

• An intervening professional as defined in Section 27-65-102(20), C.R.S.;
• Skilled professional as defined in 2 C.C.R. 502-1;
• Independent professional person as defined in Section 27-65-102(19), C.R.S.;
• Certified peace officer as defined in 4 C.C.R. 901-1, Rule 1(k), Section 21.400.1; or
• An Emergency Medical Services (EMS) provider as defined in 6 C.C.R. 1015-3:1, 2.22.

Health First Colorado members must interact with a behavioral health provider or certified peace offer in order to establish the need for BHST. Members cannot request BHST directly.

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Prior Authorization

Prior authorization is not required for behavioral health secure transportation.

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Covered Benefits and Limitations

Behavioral Health Secure Transportation (BHST) is a benefit for all Health First Colorado members who are experiencing a behavioral health crisis and require urgent transportation for behavioral health stabilization and treatment.

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Covered Services

The following services are covered:

• Voluntary and involuntary transportation
• Transportation from the site of the behavioral health crisis to the closest, most appropriate facility
• Transportation between the following types of facilities
  • An emergency medical services facility, which means a licensed or certified facility that provides emergency medical services, including but not limited to hospitals, hospital units as defined at Section 25-3-101, C.R.S.; freestanding emergency departments as defined at Section 25-1.5114, C.R.S.; psychiatric hospitals; community clinics; behavioral health entities; and community mental health centers, crisis stabilization units, or acute treatment units.
  • A facility designated by the Executive Director of DHS for the treatment and evaluation pursuant to Article 65 of Title 27 (These facilities have what is called a "27-65 designation" which means they can treat individuals receiving involuntary treatment);
  • An approved treatment facility, as described in Section 27-81-106, C.R.S. (These are substance use disorder treatment providers who hold a Substance Use Disorder (SUD) License with the Behavioral Health Administration);
  • A walk-in crisis center (WIC) that is operating as part of the behavioral health crisis response system; or
  • A behavioral health entity (BHE) licensed with a current twenty-four (24) hour endorsement pursuant to Section 25-27.6-106, C.R.S.

Records of all reimbursed BHST trips must be maintained according to CDPHE rule, county legislation, and provider policy. These records must be made available to the Department upon request. Providers must ensure that CDPHE-required and county-required records of restraint usage are maintained and all relevant documentation surrounding Health First Colorado-reimbursed BHST involving restraints is available to the Department upon request. All Health First Colorado providers are required to “maintain legible, complete, and accurate records necessary to establish that conditions of payment for Medical Assistance Program covered goods and services have been met, and to fully disclose the basis for the type, frequency, extent, duration, and delivery of goods and/or services provided to Medical Assistance Program members.” 10 CCR 2505-10, § 8.130.2.A.1.

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Exclusions

The following services are not reimbursable by Health First Colorado:

• Waiting time
• Cancellations, including response calls to locations when no transportation is needed or provided.
• Charges when the member is not in the vehicle
• Non-benefit services provided at the scene when transportation is not necessary
• Transportation which is covered by another entity
• Transportation of a member who has been pronounced deceased at the time that the transportation service arrives
• Pick up or delivery of prescriptions and/or supplies
• Health First Colorado Member directed requests for BHST
• Transportation arranged for a member's convenience when the member is not in behavioral health crisis
• Transportation when the member is chemically restrained
• Transportation when the member requires medical treatment, or active or ongoing medical monitoring
• Transportation provided by law enforcement
• Transportation where restraints were used within the context of a voluntary transport
• Transportation services provided by the Office of Behavioral Health (OBH), now known as Office of Civil and Forensic Mental Health (OCFMH) within the DHS to clients who are in the custody of CDHS,
• Transportation provided by Emergency service patrols established pursuant to Section 27-81-115, C.R.S.
• Transportation after discharge from a hospital, which is considered Urgent NEMT.

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Resources

Behavioral Health Secure Transport (BHST) Web Page

Visit the Secure Transport web page for an overview and resources regarding the regulation and authority of BHST in Colorado.

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BHST Billing Information

As a fee-for-service benefit, the 837P format (also known as CO 1500 form) should be utilized for electronic billing.

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Claim Type
BHST Claims submitted via the web portal are Professional Claims Only (837P/CO1500).

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Diagnosis Codes
A diagnosis is required on all claims. Providers should utilize the appropriate ICD-10 code that aligns with the established behavioral health crisis. If providers do not have a diagnosis from a behavioral health provider, enter code “R69, diagnosis unspecified." Do not fill unused spaces with zeros. The diagnosis must be referenced to each detail line by placing a "1" in the diagnosis indicator field.

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Dates of Services
Each detail line includes space to enter two (2) dates of service: a 'From' Date Of Service (FDOS) and a 'To' Date Of Service (TDOS). Both dates must be completed on the electronic record and must be the same date that the transportation took place because ‘span billing’ is not allowed. For services rendered on a single date, complete the FDOS and the TDOS with the same date.

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Span Billing
Span billing is not allowed for transportation services. Each detail on the claim must be for a single date of service.

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Place of Service Codes
Refer to Appendix K: Place of Service Codes located in the State Behavioral Health Services Billing Manual. Providers should utilize the appropriate place of service code where the member was picked up by secure transportation.

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Procedure Codes and Rates
The Provider Rates and Fee Schedules outline the current BHST rates and available procedure codes. The Rate and Fee Schedule is updated annually around July 1 with the new rates implemented by the legislature for the new State Fiscal Year.

* When submitting a claim, providers must use modifier ET in order to get reimbursed.

Enter whole numbers only. Do not enter fractions or decimals.

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Trips over 250 Miles

For BHST trips over 250 miles one-way, BHST providers must submit the BHST 250+ Mileage Verification form with their claim. The form must be filled out by the Behavioral Health provider who requested the BHST trip.  The Behavioral Health provider can be the same professional types who establish member eligibility.

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Multiple Trips in the Same Day

When billing for one member taking multiple trips in the same day with the same rendering provider, modifier 76 must be used.

When billing for one member taking multiple trips in the same day with different rendering providers, modifier 77 must be used.

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Timely Filing
Refer to the General Provider Information Manual located on the Billing Manuals web page under the General Provider Information drop-down menu for more information on timely filing policy, including the resubmission rules for denied claims.

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Claim Example

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Direct all claims and portal questions to the Provider Services Call Center. If your question is still unresolved, email HCPF_BHCoding@state.co.us with the call tracking number to escalate your concern.

BHST Revision Log