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Provider Manual

Provider Reimbursement Notes

Last Updated on September 04, 2019

New codes without a commercial fee

 When a new code is introduced that does not have a corresponding commercial fee, Security Health Plan will reimburse providers at 60% of their billed charge until data is available to set the fee. In an effort to update the commercial fee schedule in a timely manner, each quarter SHP will set a fee for all new codes without a fee that have been billed in the previous quarter.

Mental health code reimbursement

Mental Health codes are reimbursed at a percent of the physician rate for non-physician providers.  Reimbursement percentages of the physician fee are outlined below:

  • PhD/PsyD -  76% of physician fee
  • MSW/BCBA/BCBA-D - 67% of physician fee
  • AODA Counselor - 52% of physician fee