Blue Cross Blue Shield of Massachusetts insures many patients seeking addiction treatment, so it makes sense that addiction treatment centers and providers will often conduct searches like “Where do I find addiction treatment billing information for BCBSM?” and “What’s the billing contact information for behavioral health providers at BCBSM?”
As Blue Cross Blue Shield of Massachusetts pours more resources into addressing health inequities and racial justice in healthcare through its initiatives like it’s equity business incubator and through actions like expanding its mental health network, it’s reasonable to expect addiction treatment billing claims to increase at BCBSM. In addition to these programs, Blue Cross Blue Shield of Massachusetts contracts with larger behavioral health providers in the state like Aware Recovery Care and Brightline to deliver even more robust access to addiction treatment care for its membership base.
With behavioral healthcare needs, addiction treatment spending and outpatient mental health services all polling at sky high levels in Massachusetts as a result of the pandemic, it’s likely that Blue Cross Blue Shield of Massachusetts will continue to see a high volume of addiction treatment claims.
Here’s Where to Find Information About Submitting Original Addiction Treatment Billing Claims to Blue Cross Blue Shield of Massachusetts
Blue Cross MA provides ample information about how to submit original claims on their website. Medical providers - like behavioral healthcare professionals and addiction treatment clinics and centers - can contact provider services for claims, as well. The number to use depends on the nature of your organization.
Physicians offering addiction treatment can use: 1-800-882-2060
Hospitals with addiction treatment programs can use: 1-800-451-8123
“Ancillary Providers” (AKA everyone else) who provides addiction treatment in any other setting can use: 1-800-45108124
At BCBSM, electronic claims are processed faster than paper claims. BCBSM does not have a dedicated third party claims service that it uses. Instead, they encourage all providers to connect to their claims department using any compatible clearinghouse or via direct connection.
Billing Begins with Authorizations. Here’s the Contact Information for BCBSM’s Behavioral Health Authorizations
There is a special set of phone numbers for behavioral health authorizations at Blue Cross Blue Shield of Massachusetts that addiction treatment providers should know. That said, for in-network providers, the best way to submit prior auths (also known as PAs) is to submit them electronically via the provider portal.
If you elect to phone authorization requests into BCBSM, you can call:
1-800-524-4010
To fax in a behavioral health authorization request, use this number:
1-888-641-5199
Does it Even Require Authorization? Here’s What Types of Addiction Treatment Require Prior Auth with Blue Cross Blue Shield of Massachusetts
As you can see from the above tables, prior authorization rules at BCBSM for behavioral health and addiction treatment are very complex. Whether any given “product” triggers a prior authorization requirement depends on a variety of factors, including what type of plan the member has: Commercial HMO, PPO and EPO, Indemnity, Medicare Advantage HMO Blue, Medicare Advantage PPO Blue or FEP (also known as Federal Employee Program).
Many addiction treatment services - like acute inpatient or detox, acute residential treatment, the first unit of service for PHP or IOP, and methadone treatment - don’t immediately require prior authorization. Most of these, however, do require notification within the first 48 hours of admission and/or treatment administration.
Several levels of treatment have additional rules. For example, acute residential treatment for Substance Use Disorder also triggers a requirement at Blue Cross Blue Shield of Massachusetts that providers complete a Case Management consent form, as well as a treatment plan and a discharge plan. This all needs to happen before services are covered.
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