2017-16: Update - Age Modifiers On Behavioral Health Authorizations

Date: 04/27/17

Louisiana Healthcare Connections is conducting a claims project to review and reprocess behavioral health claims that have recently been denied due to age modifiers not being included on the claims.

Since the integration of Specialized Behavioral Health services into Healthy Louisiana on December 1, 2015, Louisiana Healthcare Connections has not required providers to submit behavioral health claims with age modifiers. However, for the period between December 1, 2016, and February 21, 2017, authorizations issued by Louisiana Healthcare Connections were built to require an age modifier. In effect, this required providers to submit claims with age modifiers, even though Louisiana Healthcare Connections did not intend for that requirement.

Effective Feb. 21, 2017, Louisiana Healthcare Connections discontinued the use of the age modifiers on authorizations, and going forward, any new authorizations and claims will not require age modifiers.

However, Louisiana Healthcare Connections recommends that providers file claims with the appropriate age modifier appended for authorizations issued on CPST (H0036) and PSR (H2017) services between Nov. 1, 2016, and Feb. 21, 2017, for the full six months of the issued authorization to eliminate the need for reprocessing, which may result in payment delays.

Louisiana Healthcare Connections is reviewing and reprocessing all affected behavioral health claims that denied for this reason. Please allow 60 days for reprocessing.

Note: Providers whose claims have been denied due to this issue are welcome to file corrected claims, with the appropriate age modifier appended, if they do not wish to wait for the completion of the claims project.