NOVEMBER 2025

🌿 BAC Office | November Newsletter

Supporting Hawaiʻi’s Behavioral Health Providers with Care & Aloha

🧠 Industry Highlights & Updates

1. Telehealth Coverage Continues

Telehealth remains reimbursable across most Hawaiʻi Medicaid and commercial plans. Many payers cite its importance for access on neighbor islands and rural communities.

Tip: Ensure correct POS and modifier usage to prevent denials. BAC Office can help verify guidelines by payer.

2. New 2025 Behavioral Health Codes (Coming Soon)

Peer Support & Community Stabilization
Mobile Crisis Support
Enhanced Case Management Tracking (H2015 / H0044 reporting changes)
Updated Family Therapy & Substance Use Treatment codes

3. Credentialing & Compliance Reminders

Requirement	Why it Matters	Support
License Renewal	Expired licenses cause claim denials	BAC Office can verify & track dates
CAQH Attestation (every 90 days)	Insurers reject credentialing when expired	We can assist with re-attestation
Updated Portal Logins	Prevents auth & claim submission delays	We can reset access & assign users

Billing Tip: Always verify the member’s line of business before submitting claims. For example, when working with Ohana, a patient may be enrolled in multiple plans, such as:

Ohana Medicare Advantage
Ohana Medicaid (Quest)
Ohana CCS (Community Care Services)

Patients often provide only one subscriber ID, but they may have more than one active plan. Most EHR or Practice Management systems pull eligibility based on the name, date of birth, and subscriber ID provided — which does not always show all active coverage. Taking a moment to check each line of business on the payer portal helps ensure claims are billed correctly the first time and reduces denials and reprocessing delays.

Billing Tip: Always confirm whether the member is enrolled in QUEST Integration vs commercial lines before billing to avoid recoupments.

🍂 Thanksgiving Schedule & Appreciation

We are incredibly thankful for all of our clients, partners, and providers across Hawaiʻi. Your commitment to community care inspires us every day.

BAC Office will be closed:
November 26th & 27th
to allow our team to celebrate Thanksgiving with our families.

🦃 Thanksgiving Medical Humor:
Why did the turkey go to therapy?
He was tired of being roasted every year. 😄

BAC Office
Billing • Administration • Credentialing
Serving Hawaiʻi with Accuracy, Integrity & Aloha 🌺

HMSA Federal Plans-Gender Identity Services Exclusion for Federal Plans

Beginning Jan. 1, 2026, surgical or chemical regimen (hormone treatments) for Sex-trait Modification to treat diagnosed gender dysphoria won’t be a covered benefit for HMSA Federal Plan 87, HMSA Plan for Postal Service Employees, and Federal Employee Program.

Members age 19 and older who received covered services or were mid-treatment in 2025 may seek a benefit exception to continue care for treatment in 2026.

brown wooden signage on green grass field during daytime

The benefit exception will need review and approval by the plan before services are rendered. Providers will need to complete the Prior Authorization Form.

Available at hmsa.com/help-center/submitting-a-precertification-request/.

Refer to prc.hmsa.com/s/ for Gender Identity Services, Gender Affirming Surgery, and Gender Dysphoria articles for Federal Programs.

HMSA/Magellan Behavioral Health Clinical Practice Guidelines:– Neuropsychological Testing:

a. Removed the exclusion for testing performed when abnormalities of brain function are not suspected.

b. Removed the exclusion for testing primarily for diagnosing Attention Deficit Hyperactivity Disorder (ADHD) considering the current prevalence stimulant misuse and in support of the additional information testing may provide vs. screening tools and behavioral rating scales to confirm a diagnosis of ADHD.

c. Revised the exclusion for testing for candidacy for medical/surgical procedures when testing doesn’t inform treatment, care of behavioral health issues.