The Centers for Medicare and Medicaid Services (CMS) established a code set to cover the Collaborative Care Model, as well as integrated behavioral health services in primary care. In the “final rule”, CMS put forth specific requirements that must be met in order to submit for payment using these codes. The requirements are aligned with the foundational elements of the Collaborative Care Model or providing care in an integrated care setting put forward by CMS.

In order to ensure adherence to these requirements, primary care providers must be able to demonstrate that they are
providing services under the Collaborative Care Model or in an integrated care setting by submitting a detailed program
description to BCBSRI. After BCBSRI reviews and approves the program description, the provider will be reimbursed
for the collaborative care and general behavioral health integration codes for services provided to BCBSRI Medicare
Advantage members, and for the collaborative care codes for Commercial members.

Effective January 1, 2019, BCBSRI will be extending reimbursement for general behavioral health integration services to
Commercial members. View this version of the Behavioral Health Integrated Services policy.

BCBSRI will inform the provider via email notification if their program description meets requirements. Providers will be
able to submit claims 60 days after program approval. No retroactive payments will be made for services rendered.

All program descriptions can be sent to: Behavioralhealth@bcbsri.org.