Reimbursement for services provided by unlicensed clinical behavioral health providers actively seeking licensure in Colorado

Effective immediately, Anthem Blue Cross and Blue Shield (Anthem) will begin reimbursing for services rendered by unlicensed clinical behavioral health providers who possess at least a master’s level education and who are actively pursuing behavioral health professional licensure who are appropriately supervised by a duly licensed and credentialed Colorado participating clinical behavioral health provider. Provider groups assigned by Anthem to Carelon Behavioral Health, Inc.* or contracted with Carelon Behavioral Health, Inc. to render services to Anthem members are included in this change.

Direct supervision by a licensed Colorado participating provider is required for any services provided by an unlicensed clinical behavioral health provider seeking licensure; such supervision must comply fully with Incident to reimbursement policy. The licensed supervising provider must:

• Be permitted—as part of their scope of practice—to supervise such unlicensed provider for services.
• Assume professional responsibility for the patient and services performed in compliance with the licensed supervising provider’s applicable licensing law and regulations.

Unlicensed clinical behavioral health providers will be required to bill under their supervising provider and will be reimbursed per the supervising provider’s contract without the need for contract changes or amendment. Anthem reserves the right to audit medical records upon request. If there is a conflict between this article and any other Anthem communication or policy, this article shall prevail.

For more information regarding direct supervision requirements, please reference incident to reimbursement policy. Visit anthem.com and select For Providers. Under the Provider Resources heading, select Policies, Guidelines & Manuals. On the next screen, select the Select a State and choose Colorado. Next, under the Reimbursement Policies heading, select Access policies.

If you have questions, reach out to your Provider Relationship Account consultant or manager.