A staff/user’s license/degree will determine which procedure codes they can bill for. This is primary-driven, meaning counties cannot alter which procedures each license type is associated with.
CalMHSA has reviewed the Billing Manuals to determine the definitions of Student, Intern. Resident, and Waivered Professional. The definitions vary only little between the DMC-ODS, DMC-State Plan, and SMHS Billing Manuals. We recommend counties get familiar with these definitions when determining how to setup a user that may fit one of these categories.
We have created the following matrix to help counties determine which License/Degree to give a staff member when setting them up in SmartCare. This matrix includes columns for the licensure tracks and rows for the levels within that track. If you find that an option is not available for the staff you’re setting up, please reach out to CalMHSA for troubleshooting.
Generally speaking, each column will have access to the same procedure codes, regardless of what level the staff member is currently at. There are a few exceptions to this. Rates are also often the same, but again there may be exceptions.
Medical Staff Considerations
Please note that Medical Students and Nursing Students generally do not bill any services themselves. They may help write notes for their Attending/Supervisor, but are not listed as the provider on any services themselves. These staff should be setup as a Proxy for any staff that they will be working under. Follow the steps in the article “How to Make a Staff/User a Proxy for Another Staff/User” for detailed instructions on how to setup a proxy.
If a person is a Medical Resident in one program and is moonlighting as an MD in another program, this person should have 2 separate accounts setup in SmartCare. This will allow them the correct procedure codes and signature for their different roles. This should be very rare.
When a person becomes a certified Psychiatrist, change their license from MD/DO to Licensed Psychiatrist. This is for state reporting purposes. Procedure codes will not be impacted.
Non-ACGME Fellows/Moonlighters are operating at the level of licensed physician (MD/DO), though they may not be board certified. Choose the appropriate license of either MD or DO, based on their credentials, for these staff.