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Newly certified CCBHCs report unpaid claims; MCOs and DMS point to billing errors and credentialing lag
Summary
Several newly certified community behavioral health centers (CCBHCs) told the TAC they are not receiving payments for services effective Jan. 1 because claims lack CCBHC identifiers or contain taxonomy errors; MCOs said they are processing corrected claims, conducting outreach and will work with DMS and providers to resolve back payments.
Providers and MCO representatives told the TAC that onboarding six newly certified CCBHCs produced claim-processing problems that have created cash-flow pressure for the clinics. Steve Shannon summarized provider reports that many claims were submitted incorrectly (missing the t104 taxonomy or q2 modifier) and that some contract addenda and credentialing steps took longer than expected after the Jan. 1 effective date.
"This is a real cash flow challenge because you can't bill as a CMHC," Shannon said, explaining that claims edits and incorrect line items prevented automated processing. Several MCO representatives said audits of early submissions revealed frequent coding errors; Molina's Jeff Chapman said Molina is processing claims and has executed contract amendments where requested, and Humana and UHC representatives reported feeding edits and provider outreach to help correct submissions.
Chelsea from DMS contract monitoring said the agency asked MCOs for weekly updates on provider loading and credentialing; she expected most new CCBHC rates to be effective Jan. 1 retroactively once credentialing and loading are complete, but could not definitively say when back payments would be issued. Providers pressed MCOs to confirm whether payments would be sent by April 1; MCOs said many planned to begin processing by then but timelines varied and some claims required remediation.
Several MCOs acknowledged an education gap and said provider advocates would work directly with new CCBHCs to correct claim lines. One MCO said an early audit showed that only about 15 of 300 claims were ready to pay without correction. DMS staff said training materials (PowerPoints) were available on the CCBHC web page, and MCOs urged providers to use the t104 taxonomy and q2 modifier to identify CCBHC services.
Next steps: MCOs will continue provider outreach, DMS contract-monitoring will track weekly updates and the TAC will follow up at the next meeting if significant back-payment issues remain.
