Blue Cross Blue Shield of North Dakota (BCBSND) wants to provide additional details regarding the peer support specialist benefit.
A peer support specialist is a person who uses his or her lived experience of recovery from symptoms of mental health and/or addiction, plus skills learned in formal training, to deliver services to promote mind-body recovery and resiliency. Peer support complements and is supplemental to clinical services. The role of a peer support specialist is distinct and does not replace the clinician. The addition of peer support specialists will enhance the care options available for behavioral health diagnoses and can assist in improving a member’s health.
Peer support can help in many ways, including, but not limited to:
- Foster encouragement of personal responsibility, self-determination, health, and wellness
- Support engagement, collaboration, and communication with the treatment team
- Reduce re-hospitalization rates
- Reduce days of inpatient care
- Increase use of outpatient services
To provide peer support services, the below steps need to be completed prior to rendering services.
- Enroll as a North Dakota Medicaid provider with the State of North Dakota.
- Make sure to enroll all affiliated clinics and providers who may be rendering services.
- If you are not already, contract with BCBSND by emailing providercontracting@bcbsnd.com to contact our Provider Contracting department.
- Providers who want to see Medicaid Expansion members will also need to sign the Medicaid Expansion 1915(i) Services Provider Participation agreement and the Medicaid Expansion Provider Group Participation Agreement.
Those who provide peer support services do not need to do separate credentialing paperwork, as long as the peer support specialist has enrolled as a North Dakota Medicaid provider.
These policies outline additional peer support details:
- The BCBSND Peer Support policy.
- The Psychiatric and Substance Use Services Guidelines policy shows what peer support is included in such as Intensive Outpatient Program (IOP), Partial Hospitalization Program (PHP), Residential Treatment Center (RTC).
The Peer Support Services form
- It is recommended to use it for Medicaid Expansion. Completing this form in its entirety during the precertification process decreases the need to request additional information which can slow down the process.
- If a provider does not request precertification for peer support, commercial plan members who don't require precertification, you do not need to fill it out.
Below is additional information regarding peer support for Commercial and Medicaid Expansion.
Commercial
- Covered effective Jan. 1, 2023, call the Provider Service Center to determine specific plan eligibility and benefits.
- Enrollment as a North Dakota Medicaid provider with the State of North Dakota is required even if you will not participate in the Medicaid Expansion network with Blue Cross Blue Shield North Dakota (BCBSND). Enrollment with North Dakota Medicaid is required in lieu of credentialing with BCBSND.
- No precertification required.
- Providers should still verify the service being rendered does not require precertification by utilizing the Precertification tool.
Medicaid Expansion
- Covered effective Jan. 1, 2023, call the Provider Service Center to determine specific plan eligibility and benefits.
- Precertification required-covered as an in-lieu of service.
- Utilize the Medicaid Expansion precertification tool to search for the service you plan to provide. Precertification requests will be submitted through the Availity Essentials portal.
- Medicaid Expansion members can receive peer support services as a standalone benefit and receive 1915(i) additional services but cannot duplicate peer support services in both programs.
Questions?
If you have any questions regarding the peer support benefit for your patient, please contact the Provider Services Center phone number on the back of their ID card.
