Behavioral Health

Only the clinician providing the services can bill LifeWise. The clinician providing the services must be cited as both the rendering and servicing provider. Providers must be credentialed with LifeWise prior to seeing our members. LifeWise doesn’t credential associate-level providers.

LifeWise can’t advise providers on billing and coding. You can consult with other providers in your community or talk to a behavioral health medical billing specialist.

View our telehealth/telemedicine services payment policy.

You can submit your claims to LifeWise electronically by signing up with Office Ally, a free full-service clearinghouse. You can order a current copy of the American Medical Association's Professional CPT Codebook on Amazon.com, OPTUM360coding.com or AAPC.com.

More resources:

Washington Council for Behavioral Health

Washington State Health Care Authority

If you're a new or returning behavioral health provider, visit the Join Our Network page for credentialing forms and information.

It's important that your patients (and potential new patients) know how to find you. If you have any changes to your practice, you can email us.

To add a provider to your clinic, email us to verify the provider's credentialing status with LifeWise. If you're not credentialed with LifeWise, visit the Join Our Network page to see how to submit credentialing documents.

LifeWise (or a vendor on behalf of LifeWise) may request medical records for HEDIS^® or commercial risk adjustment purposes. As a contracted provider, you're responsible for promptly providing these records to LifeWise.

You'll find all the credentialing forms and information you need on our Join our Network page.

Licensed assistant behavior analysts (LABAs) don't need to get credentialed through LifeWise. Their services are billed under the credentialed, supervising licensed behavior analyst (LBA).

Both Microsoft and Amazon follow the same standard process and fee schedule rates.

During supervision, only LBAs can be billed for their time. Certified behavior technicians' (CBTs) supervising time isn't a covered service since the supervision is being delivered by the program manager/lead behavioral therapist. (CBTs include therapy assistants, behavioral technicians, and paraprofessionals.)

However, when a program manager/lead behavioral therapist is supervising a CBT while they're providing direct treatment services, both the supervision by the program manager/lead behavioral therapist and the direct treatment services by the CBT are covered services. Prep time is not covered. During supervision of direct treatment, both the LBA and the CBT need to create separate chart notes. For supervision that doesn't occur during direct treatment, only a chart note by the LBA is necessary.

For claims and payment information, claim status, detailed payment information and EOPs:

Individual plans: Sign in to Evolent
Group plans: Sign in to Availity

In addition to autism spectrum disorder (ASD), ABA therapy also covers autism and pervasive developmental disorders. This includes:

• Autistic disorder
• Rett's syndrome
• Asperger's syndrome
• Other childhood disintegrative disorder
• Pervasive development disorder unspecified

A patient's treatment plans, as a standard, should be updated every 6 months. A treatment plan should be kept on file in the office and doesn't need to be sent to LifeWise unless requested for an audit or medical records request.

For general guidance about coverage criteria for ABA services, see our medical policy 3.01.510. In addition, many member benefit booklets provide specific coverage criteria for ABA services.

Some portion of the direct service provision (no specific time amount is specified) may take place in a school setting when behavioral or other difficulties that are manifestations of the individual's autism spectrum disorder (ASD) are evident and problematic in a school setting. Direct service provision in a school setting must consist entirely of bona-fide ABA treatment activities; the ABA clinician can't be used as a classroom aid for the patient, as a 1:1 teacher for the patient, or in any other capacity that is a function of and the responsibility of the school system.

Assisting the member with schoolwork or functioning as a tutor isn't covered, except when they have demonstrated a pattern of significant behavioral difficulties during schoolwork. Provision of services that are part of an individualized educational plan (IEP) that should be provided by school personnel and other school-obligated services are also not covered.

An LABA can provide services as a program manager under the supervision of an LBA per the license requirement. LABA's services are billed under the supervising LBA's name. The LBA's time supervising the LABA isn't reimbursable under the plan; only the time the LABA spends on covered program manager activities is billable.

Team meetings are only covered when they're specifically for treatment plan development or revision or case review for one specific patient. Prep time including charting data or plotting graphs, as distinct from actual analysis of data, aren't covered.

Direct service provision by telehealth modalities, including to parents or family members, isn't medically necessary because there's no credible scientific evidence that the provision of ABA by telehealth modalities is effective or safe. Therefore, direct service provision by telehealth modalities isn't covered.

Supervision may be conducted entirely in person or may be a combination of in person and remote, but some portion of the supervision (no specific time amount is specified) should be conducted in person.

The following are considered unnecessary duplication of services and therefore not medically necessary in the provision of ABA services:

• More than one program manager/lead behavioral therapist for a member at any one time
• More than one provider group/clinic/agency/organization providing ABA services for a member at any one time
• More than one clinician (program managers/lead behavioral therapists, or CBTs, or program manager/lead behavioral therapist and CBT) providing direct ABA treatment services to the same member at the same time

Exception: Amazon and Microsoft allow 2 program managers at the same time.

As of 2019, CBTs can now provide group therapy as a covered service. However, CBTs can't assist with occupational or speech therapy because it's not in their legally authorized scope of licensure. CBTs should receive weekly clinical supervision from the program manager/lead behavioral therapist as follows for each patient: Generally, 2 hours for every 10 hours of direct service provision, with a minimum of 2 hours weekly when direct service provision is 10 hours per week or less. This is a standard used by the Behavior Analyst Certification Board.

ABA services by a family member, live-in nanny, or au pair are not covered. ABA services by a provider functioning as a live-in nanny or au pair also aren't covered. In addition, our plans only cover training for parents and guardians. Nannies and au pairs can't be trained in parent training.

You'll find all the credentialing forms and information you need on our Join our Network page.

Coverage

To check member benefits, submit claims, get claims status, detailed payment information, and explanation of payments (EOPs):

For LifeWise group plans, sign in to Availity. If you have questions, call customer service at 800-592-6804, Monday through Friday, 6 a.m.-6 p.m. PT.

For LifeWise individual plans, sign in to Evolent. If you have questions, call customer service at 800-817-3056, Monday through Friday, 8 a.m.-6 p.m. PT.

Billing

• Mobile crisis response services should be billed on a CMS 1500 form.
• Check the Washington State Healthcare Authority's applicable SERI guide and your contract to determine which services you should be billing. You're required by contract to bill claims with complete and accurate coding that reflects actual services provided at the time of service.
• LifeWise doesn't permit fragmented or split professional billing, defined as professional services rendered by the same provider for the same date of service and submitted on multiple professional claim forms.
• All services rendered by the same provider for the same member and date of service must be billed on a single claim form. LifeWise has claim edits in place to ensure accurate claims processing.

Note: The information above applies to most services. CPT codes can change over time and LifeWise expects all BH-ASOs and providers to be current on the latest billing regulations and guidelines.

Referrals

When directing members for follow-up care, use in-network providers when clinically appropriate, to minimize the member's out-of-pocket expenses. To find a provider in-network with the member's plan please reference the Find a Doctor tool.

Case Management

This voluntary service is offered to participants with health complexity, high utilization, and functional impairment. Health complexity encompasses multiple diagnoses, physical and mental health co-morbidities, personal, social, and financial upheaval, and health system issues. Integrated Case Management works cooperatively with members and physicians to identify and overcome clinical and non-clinical barriers to improve health outcomes.

Providers can refer eligible LifeWise members to care advising programs or ask questions about the programs.

LifeWise group plans: Call 800-592-6804. Representatives are available from 8 a.m. to 6 p.m., Monday through Friday.  Referrals can also be made via secure fax at 206-806-7455.

LifeWise individual plans: Call 800-817-3056. Representatives are available from 8 a.m. to 6 p.m., Monday through Friday.  Referrals can also be made via secure fax at 206-806-7455.

• SERI guide
• American Medical Association
• 988 Lifeline
• Payment Policies
• Medical Policies