Anthem Blue Cross and Blue Shield will begin reimbursing for services provided by unlicensed clinical behavioral health providers actively seeking licensure in Connecticut

Effective as of August 1, 2023, Anthem began reimbursing for services provided by unlicensed clinical behavioral health providers who possess at least a master’s level of education and who are actively pursuing behavioral health professional licensure. Anthem considers these clinical behavioral health providers as auxiliary personnel as stated in the Incident To reimbursement policy referenced below (select Access Policies). The care provider groups assigned by Anthem to Carelon Behavioral Health, Inc.* are included in this change. Reimbursement will be based on the supervising care provider. 

Direct supervision by a licensed Connecticut participating care provider is required for any services provided by an unlicensed clinical behavioral health provider seeking licensure; such supervision must comply fully with the Incident To reimbursement policy. The licensed supervising care provider must be permitted to supervise such unlicensed care provider for services within their scope of practice and assume professional responsibility for the patient and services performed in compliance with the licensed supervising care provider’s applicable licensing law and regulations. The licensed supervising care 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 care provider’s applicable licensing law and regulations.

 Unlicensed clinical behavioral health providers will be required to bill under their supervising care provider and will be reimbursed per the supervising care provider’s contract without the need for contract changes. 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 by visiting Anthem.com, > For Providers > Policies, Guidelines & Manuals > Select a State (choose Connecticut) > Reimbursement Policies > Access policies > Scroll to page 5 and select Incident To. 

If you have any questions, reach out to your Provider Relationship Management consultant. 

We’re committed to active involvement with our care providers partners and going beyond the contract to create a real impact on the health of our communities.