Claims analysis of claims billed using the HL modifier

Anthem embraces opportunities to foster collaboration efforts with providers to help ensure proper coding and payment of claims. To this end, we regularly review the Indiana Health Coverage Programs Provider Reference Modules to ensure we are processing claims in a way that is consistent with state guidance.

This letter is sent as a reminder that, per the Indiana Health Coverage Programs (IHCP) Provider References Module for Behavioral Health Services (p. 6) and in accordance with BT201859:

• The IHCP allows reimbursement for services provided by interns in the community mental health center (CMHC) setting. The provider billing for these services must be enrolled with the IHCP as a CMHC (provider type 11, specialty 111). CMHCs owned by or affiliated with a hospital, however, are an exception to this allowance. CMHCs associated with hospitals may not bill separately for intern services because reimbursement for intern services is included in the hospital’s medical education add-on to inpatient claims.
• To qualify for reimbursement, the intern must be a graduate or postgraduate student currently enrolled in an accredited college or university program in one of the following fields of study:
• Medical (including physician assistant)
• Nursing
• Behavioral health (including mental health and addiction treatment)

Further, the student must be approved by the college or university to work as an intern or practicum student at a CMHC.

For reimbursement, the intern must be supervised by an IHCP-enrolled practitioner who is employed by or under contract with the billing CMHC. The services rendered by the intern must be within the supervising practitioner's scope of practice. The following billing guidance applies to services rendered by interns:

• Services must be billed on a professional claim (CMS-1500 claim form or electronic equivalent).
• The supervising practitioner should be listed as the rendering provider on the claim.
• The modifier HL (intern) should be used to indicate that the service was performed by an intern.
• Reimbursement for intern services is at 50 percent of the professional fee schedule amount published on the Professional Fee Schedule, accessible from the fee schedules page at in.gov/medicaid/providers.

We are grateful for your care of our members and look forward to continued collaboration.