Alliance Rates for Medicaid BH Services

Taxonomy Verification
In preparation for Medicaid Direct and the Tailored Plan launch on July 1, 2024, Alliance will reimburse services provided according to the taxonomy billed for Medicaid and State services.

Under the Tailored Plan, Alliance will only be able to maintain separate rates for behavioral health services when there is an applicable psychiatric taxonomy to apply in our claims system. These rates may be higher than the DHB rates. Please take note of the changes being implemented.

Physicians
Effective with the Tailored Plan, Alliance will pay a specific behavioral health rate when one of the taxonomies below is billed on the claim. This applies to only a subset of services as published on the DHB Medicaid Fee Schedules for Psychiatry Behavioral Health Physician Services and Psychiatric Mental Health Nurse Practitioner. If another taxonomy is billed, the claim will pay according to other DHB Medicaid Fee Schedules. Please note that if the taxonomy being billed is NOT registered in NCTracks for your provider, the claim will be denied. 

Nurse Practitioners
Effective with the Tailored Plan, Alliance will pay a specific behavioral health rate when one of the taxonomies below is billed on the claim. If another taxonomy is billed, the claim will be denied. Effective with the Tailored Plan, the standard Medicaid Nurse Practitioner rate will pay when a non-behavioral health/psychiatric taxonomy is billed. Please note that if the taxonomy being billed is NOT registered in NCTracks for your provider, the claim will be denied. 

Physician Assistants
Alliance follows the DHB Medicaid Physician Assistant fee schedule. There is not a separate psychiatric taxonomy for Physician Assistants. As such, Alliance is unable to maintain specific behavioral rates. You may see a decrease in your Physician Assistant rate on July 1, 2024, if the Alliance rate is currently higher than the DHB published rate.

Clinical Nurse Specialists
Alliance will implement a separate fee schedule according to the DHB Medicaid Clinical Nurse Specialist fee schedule. The rates will only apply to the services listed on the fee schedule. These services will pay when the taxonomy listed below is billed. Please note that if the taxonomy being billed is NOT registered in NCTracks for your provider, the claim will be denied.

Please note that the DHB fee schedule includes Psychiatric Nurse Practitioner taxonomies, however, the rates are equal to the rates on the Psychiatric Mental Health Nurse Practitioner fee schedule.