Telemental Health Georgia Rules: Will Insurance Pay?
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*3/15/20: I will update this page as soon as possible. The process has been streamlined with Anthem and there are many more third party payers who have entered the market with telemental health protocols since this post was written in 2015. *
This article will inform the reader of Anthem Blue Cross planned services and they are related to the new telemental health rules in Georgia.
Anthem Blue Cross: TeleMental Health Defined
According to an undisclosed source with Anthem, effective January 1 2016 Anthem Blue Cross (formerly known as Wellpoint) will introduce a video conferencing service delivery system. Eligible psychologists, LPC, LCSW and LMFT may be reimbursed through this system. Psychiatrists are not included in this program.
Anthem defines Telemental Health specifically as live, interactive video conferencing–electronic face-to-face contact as the vital element. TeleMental health Georgia rules also include video conference in their definition. Georgia LPC LCSW and MFT rules define TeleMental health as a “mode of delivering services”.
Anthem requires it’s members and providers to utilize a web application (app). This app is a sophisticated system that has built into it aspects ranging from member payment to authorization and claims submission. This allows Anthem to ensure HIPAA and other privacy compliance and provide a structure: the live interactive video conferencing session will be extensively automated. Services will likely include 45 minute sessions.
How do I become an eligible telemental health provider with Anthem?
Basic criteria for eligible psychologists, LPC, SW and MFT are:
1) Current State License and Malpractice Insurance
2) Completion of 6 hours of telehealth education. These hours may be obtained online.
3) Members accessing telemental health must reside in the same state as the counselor/therapist.
You may contact your Provider Relations representative to determine if additional information is available. However, eligibility criteria allow for a straightforward approval process for currently contracted mental health providers.
How does Anthem’s system work with regards to the new Georgia TeleMental health rules?
(Here are my “Former Board President’s Practical Guidelines“ for reading GA Board Rules. This information is both reliable and practical.)
Now retrieve the Georgia Telemental Health Rules at Chapter 135-11 from the GA Secretary of State website. The link will open in a new window. Note the Composite Board CE requirements as they will likely be similar to Anthem’s finalized requirements.
I don’t want to do TeleMental health. Can I choose to simply continue to schedule and see my BCBS clients in my office?
Yes. Becoming a TeleMental health provider with Anthem is elective. You may choose to continue to deliver the mode of face-to-face psychotherapy. Nothing has changed with Anthem regarding electronic communications including scheduling, crisis calls, email and so on.At present, Anthem will not reimburse any electronic communications (Skype, telephone counseling) outside of their web application.
1) Anticipate that you will need a minimum CE/training requirement if you choose to deliver TeleMental health services.
2) It is likely other managed care organizations will implement TeleMental health services within a similar framework as Anthem.
3) Becoming a TeleMental health provider is voluntary with Anthem BCBS.