Some of your Modern Health clients may be eligible for continuity of care therapy sessions with you, as offered by their employer. We’re so pleased about this feature because it means that we now have the ability to offer additional care for those members who need it (when eligible)! We are providing below an overview of this feature. Please note, this FAQ is not all-encompassing and we will continue to provide more information, including changes to the provider dashboard, as we are able.
Why is Modern Health making this shift?
Modern Health made this update in an effort to extend care to members beyond the initial allotment of sessions sponsored by their employer, without placing all of the costs on the employer or employee. To do this, we have set up partnerships with insurance networks so that “overage” sessions are submitted to the employer for payment via its health plan, after assessing a cost-share portion to the employee. Please note, this will only be offered to members who are enrolled in their employer’s self-funded health plan and whose employer agrees to set up the health plan integration with us. This isn't open to our entire member base.
What are the main changes in the provider experience?
- We require a few additional pieces of information which we will include on all invoice submissions for providers rendering continuity of care sessions through HPI. This will include asking for diagnosis or DSM code and CPT codes (diagnostic and therapeutic procedure codes).
- We also will be sending an updated agreement that asks that you take notes during your sessions that you would be willing to share with us in the event that a claim was denied and we needed to further substantiate why the service was provided.
- This does not change how you are paid for services provided. We will still make payment on our current schedule as we know this is one of the benefits of working with us rather than an insurance network. Since our invoices to the employer are through the health plan, questions may arise regarding information you provided. We will communicate any questions to you and resolve them.
What are the main changes in the member experience happening in this project?
- If members want to access additional sessions, they will need to provider Modern Health information so that we can check their eligibility.
- Members will also need to fill out payment information to allow us to assess any cost-share associated with the visit as determined by the employer. Most employers are electing to follow the cost-share structure of the health plan for simplicity.
Which providers are impacted by HPI?
This is only applicable to US-based therapists at the moment
What information will be provided to the health plan?
- On the invoice, we may share your full name and NPI
- Some of the health plans may require additional information to set-up a separate network specific to Modern Health such as full name, NPI, license, and specialty
Will my rates be impacted by Modern Health working with health plans?
Your rates will not be impacted by Modern Health working with health plans. Your rate and payment schedule will remain the same as contracted with us.
Will payment timelines be impacted by working with health plans?
No, we will still make payment on the same cadence that we have been.
Do I have to submit a code for every session?
You will need to submit a CPT and Diagnosis code for each overage visit. For non-overage visits, the invoice form will remain the same and will not require additional information.
What if a code I want to use isn’t available on the dashboard?
Please let us know which code you would like to have considered and documentation for why that is. We will provide this information to our Compliance team and will follow up with their decision.
What if a client wants to pay out of pocket rather than have claims submitted?
The client can. In this case, overage sessions are arranged with the provider independent of Modern Health. Similarly, such sessions should be conducted outside the Modern Health platform.