Health Care Homes Incentives and Payments
HCH Care Coordination Billing
Billing and reimbursement for HCH care coordination is different depending on payers. Each clinic or organization should begin with an understanding of the payer mix of their population to determine reimbursement approaches.
Resources for HCH care coordination services reimbursement are listed below by payer.
Certified HCH providers may receive per member per month reimbursement for the delivery of care coordination services to MHCP recipients who have complex and chronic medical conditions. The Minnesota Department of Human Services (DHS) administers MHCP.
The following information may guide you in the billing process:
- MHCP Provider Manual – Physician and Professional Services – HCH [DHS website]
- Resource for billing care coordination (PDF)
- Tiering Tools
- Managed Care Organization Contacts for MHCP providers [DHS website]. Contact the MCO directly for MCO-enrolled patients.
- Behavioral Health Home (BHH) Services [DHS website]. Note: only one care coordination service, HCH or BHH, can be billed for a patient at a time.
Reimbursement for HCH care coordination depends on the contract arrangements your organization has with each payer. Each payer reimburses differently and needs to be contacted directly about billing for care coordination. Some contract arrangements may allow per member per month or up front reimbursement for care coordination. Often, commercial insurers do not automatically offer reimbursement; therefore organizations must specifically request it.