Q: How important is it to indicate diagnoses codes when submitting a claim?
A: It is very important to indicate on the claims form the accurate diagnoses (including secondary diagnoses) for the enrollee/member. MHNet utilizes this information for quality review, analysis and improvement activities. These initiatives enhance the treatment and service for the members receiving care through MHNet.
Q: Who do I contact to become part of the MHNet Behavioral Health Network Panel or if I have questions about the application process?
A: You may direct any questions you have about joining our network to our network development team at our Corporate Headquarters.
MHNet Behavioral Health
PO BOX 209010
Austin, TX 78720-9010
(888) 646-6889
You may also submit an application request using our online request form by clicking here.
Q: Who is responsible for collecting deductibles, co-payments and co-insurance?
A: Practitioners are responsible for collecting patient deductibles, co-payments and co-insurance. MHNet will reimburse the practitioner the appropriate fee identified in the fee schedule minus any deductibles, co-payments or co-insurance.
Q: Who do I contact regarding eligibility benefits?
A: Please call the appropriate regional MHNet phone number (found on the patient’s insurance card) to verify patient eligibility status.
Q: Who should I contact regarding Certification of Services, Inpatient Admissions, Outpatient Treatment, and Outpatient Structured Substance Abuse and Treatment?
A: All services, inpatient and outpatient, must be pre-certified by calling MHNet Utilization Management at the appropriate regional number. MHNet’s staff is available on-site, 24 hours a day to pre-certify services. Services not pre-certified will not be covered, even if medically necessary. Members may not be billed for unauthorized service(s). If it is a life-threatening emergency, send the patient to the nearest Emergency facility and contact MHNet with information regarding the patient’s condition and where the patient was sent. MHNet will initiate the pre-certification process. You will be requested to share clinical information with our Utilization Management Department.
Q: What are your guidelines regarding sessions per day?
A: Both inpatient and outpatient therapy services are limited to one service per day based on certifications.
Q: What are your guidelines regarding psychological testing?
A: All psychological testing must be pre-certified to be covered. A psychological testing form needs to be completed and sent to MHNet for approval of hours/tests. Approval will be phoned to the practitioner.
Q: What are your guidelines regarding referrals?
A: All referrals of members should be made to in-plan practitioners and must be pre-certified. Call MHNet at the regional number when making a referral.
Q: Who should I contact for Claims information?
A: MHNet utilizes Payerpath, a Misys Company as our clearinghouse. You can submit your claims from your practice management software to your current clearinghouse/vendor who will forward the claim to Payerpath or you can submit the claim directly to Payerpath. To contact Payerpath for more information you may access their website at www.payerpath.com or call 1-877-623-5706.
MHNet also offers providers an on-line method to submit claims via MHNet's website. After a simple registration process you can start submitting your electronic claims within five business days. To register you must be a participating provider and complete a Trading Partner Agreement (TPA). The agreement is a HIPAA requirement and must be signed prior to submitting electronic claims via our website. TPA agreements can be found by clicking here. Please read and sign the document and submit it to the address below.
All paper claims and TPA forms should be submitted to:
MHNet Claims Department
PO Box 209010
Austin, TX 78720-9010
All paper claims should be submitted on the CMS-1500 (outpatient) or the CMS-1450 (inpatient) forms. For claims questions call (866) 992-5246.
Q: What is MHNet’s policy regarding financial incentives?
A: MHNet pays practitioners and organizational providers based on a fee-for-service schedule. MHNet does not pay practitioners or others in a way that encourages denials of coverage or service of care. At MHNet, utilization management decisions are based on the appropriateness of care and services and verification of coverage.
Q: Why do I need to complete an Outpatient Treatment Report (OTR)?
A: MHNet manages all treatment provided and routinely utilizes the information you provide to evaluate for risk factors. Additionally, we use the OTR form to help us decide if the member may benefit from many of the programs MHNet provides. MHNet has made every effort to make this form concise and easy to complete. For a copy of our OTR form, please click here.
Q: Why does the OTR require patient signature and consent to release?
A: MHNet believes that the best treatment for members is coordinated between behavioral health as well as medical providers. We expect you to coordinate care as appropriate for each member. In addition, for those members that provide consent, MHNet sends notification and/or the OTR to the members Primary Care Physician. This process ensures that the PCP has the latest information on risks factors and medications.