Behavioral Health APCM & BHI Enrollment Checklist

Screen for patients with two or more chronic conditions such as MDD, GAD, Bipolar Disorder, or OUD expected to last 12+ months.

Confirm the patient is currently prescribed psychiatric medications requiring regular monitoring and titration.

Utilize PHQ-9, GAD-7, or MDQ scores to document the clinical necessity for high-intensity APCM intervention.

Assign appropriate diagnosis codes to align with G0568 (low), G0569 (medium), or G0570 (high) complexity tiers.

Check if the patient has previously been enrolled in Behavioral Health Integration to determine stacking eligibility.

For SUD patients, secure the granular consent required to share treatment data across the care team.

Record verbal or written consent specifically for APCM services, ensuring the patient understands their cost-sharing obligations.

Ensure your enrollment workflow aligns with state-specific regulations regarding psychiatric care coordination.

Ensure your AI phone system provider has a signed Business Associate Agreement covering behavioral health data.

Clearly inform patients of their right to opt-out of the chronic care program at any time without affecting standard care.

Confirm that enrollment documentation supports Ryan Haight Act requirements for remote prescribing of controlled substances.

Set up automated, empathetic voice outreach to explain the benefits of APCM to eligible psychiatric patients.

Deploy AI triggers to contact patients immediately after a missed medication management or therapy session.

Use AI voice assistants to collect monthly PHQ-9 or GAD-7 updates via phone to meet APCM documentation standards.

Program the AI call center to identify crisis keywords and immediately route patients to the on-call psychiatrist.

Automate the 20-minute minimum monthly contact requirement using AI to confirm medication adherence and stability.

Ensure the billing system is configured to capture both the APCM base code and the BHI add-on for qualifying patients.

Implement a system to log the non-face-to-face time spent by the care team on psychiatric coordination.

Verify Medicare Advantage or commercial payer coverage for the new 2026 behavioral health add-on codes.

Ensure the electronic care plan is accessible 24/7 to all providers involved in the patient's behavioral health journey.

Analyze the per-patient-per-month (PPPM) revenue increase from automated APCM enrollment versus manual efforts.