Admissions

Behave Community is Live! Explore Security-Conscious B2B Networking for Behavioral Health Organizations

Is your behavioral health organization looking for ways to network with other organizations in the behavioral health space? There’s an app for that.

Creative Ideas for Improving Addiction Treatment Accessibility Rates Capture the Imagination 

The answer to the addiction treatment accessibility problem seems obvious: simply make it easier for people who are suffering from SUD to access the care they need. The reality is not so simple. 

Here's How to Find the Addiction Treatment Billing Claims Address for Blue Cross Blue Shield of Minnesota

Blue Cross Blue Shield of Minnesota is still accepting paper billing claims from addiction treatment centers but they are NOT accepting all utilization management forms by mail.

Where to Find Addiction Treatment Billing Contact Information for 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.

Where Can I Find Addiction Treatment Utilization Forms for Premera Blue Cross?

The primary form addiction treatment providers are required to fill out when dealing with Premera Blue Cross is the prior authorization request form.

Making Sense of Blue Cross Blue Shield of North Carolina's Average Length of Stay Per Level of Care for Addiction Treatment

Given what we know about BCBSNC’s poor track record with behavioral health parity, we can assume that their average length of stay per level of care for addiction treatment is below industry standard and likely below the national averages, as well.

Top 5 Addiction Treatment Diagnosis Codes to Use for URs with Healthfirst Insurance

There is no “best” addiction treatment diagnosis code (or ICD-10 code) to use when completing URs or authorizations with Healthfirst. All behavioral health diagnosis codes are subject to more or less the same utilization management decision making criteria at Healthfirst.

Understanding Addiction Treatment Discharges and Discharge Rules at Horizon Blue Cross Blue Shield of New Jersey

In network providers as well as out of network providers must complete a discharge plan before engaging patients in many addiction treatment services at Horizon Blue Cross Blue Shield of New Jersey.

What Addiction Treatment CPT Codes Require Pre-Certification at Highmark, Inc.?

Today, we’ll look at what addiction treatment providers need to know about Highmark Inc, including what CPT codes require pre-certification at Highmark.

Where to Find Addiction Treatment Utilization Forms for L.A. Care Health Plan 

What Utilization Forms or Utilization Reviews are Needed for Addiction Treatment Centers Working with LA Care Health Plan?

How to Complete Registration as a Provider or Pharmacy with Express Scripts, Inc. for Addiction Treatment Centers

registration express scripts addiction treatment center provider in network participating

Express Scripts is the largest pharmacy benefit management organization in the United States. It also operates one of the nation’s largest by-mail pharmacies. Over 85 million people receive pharmacy coverage through Express Scripts. The company counts revenues in excess of $100 billion per year. Express Scripts works with many different health insurance payers - government plans, employer plans, and personal plans - to cover the pharmaceutical piece of health insurance. Express Scripts was acquired in recent years by Cigna, and is also associated with Evernorth, a Cigna company. 

How to Work with Addiction Treatment Patients Who are Express Scripts Members 

addiction treatment MAT suboxone buprenorphine methadone express scripts registration

There are several situations where an addiction treatment center may need to deal with medical billing for Express Scripts. 

The main Express Scripts-related situation most addiction treatment providers will encounter is when an addiction treatment center offers Medication Assisted Treatment (or MAT) for patients in addition to other types of behavioral health services. Examples of common MAT drugs include methadone, Suboxone and Vivitrol. 

When providing MAT in-house, addiction treatment centers will be required by federal guidelines to have a medical professional, whether that's a practice nurse, physician assistant, or advanced-practice pharmacist, on staff to dispense medication. Many states require additional credentials or conditions on top of these blanket federal requirements, so check your local regulations to be sure that you're complying with all applicable laws and regulations. 

Are Addiction Treatment Centers Who Dispense MAT Considered “Providers” or “Pharmacies” by Express Scripts? 

There is no single answer to this question. It depends on how closely you decide to work with Express Scripts at your addiction treatment facility. 

If you want to be treated as an enrolled pharmacy with Express Scripts, you’ll need to complete credentialing and enroll as a participating pharmacy. In order to do that, you can email Express Scripts at NetworkCompliance@express-scripts.com with your pharmacy NCPDP number. Express Scripts urges all would-be participating pharmacies to remember that it can take up to 30 days to actually complete the enrollment process after Express Scripts receives your signed contract and completed application. 

If you want to be treated as a provider, you do not need to complete an enrollment process. However, you will need to decide how you want to submit Prior Authorization requests.

What Addiction Treatment Medications Does Express Scripts Cover?

addiction treatment medications covered by express scripts registration

Unlike its leading competitor, CVS Health, Express Scripts covers both methadone and buprenorphine in its formulary. (FYI - A “formulary” is just the technical term for a list of medications that a pharmacy benefit company covers.) Generally speaking, members can access both types of medications, although there are restrictions on certain specifics. For example, certain sublingual film versions of the drugs aren’t covered and name-brand Suboxone isn't covered, while the FDA-approved generic version of buprenorphine is covered by Express Scripts. 

When Does Express Scripts Require Prior Authorizations for Addiction Treatment Centers?

prior auth authorization addiction treatment express scripts

Express Scripts requires prior authorizations for many medications, including some medications associated with addiction treatment. 

Specifically, Express Scripts requires prior authorization for buprenorphine. 

However, Express Scripts does NOT require prior authorization for methadone. 

Many psychiatric medications, including many antipsychotics and antidepressants, do require prior authorization with Express Scripts. At addiction treatment centers, it’s not uncommon for dual diagnosis patients to be prescribed medications such as these, as well.  

How Do I Complete a Prior Authorization with Express Scripts for my Addiction Treatment Centers’ MAT Medications? 

prior authorization express scripts MAT treatment center billing registration

Fortunately, Express Scripts offers providers many options for completing prior authorizations. 

You may: 

-Use an EHR with built-in ePA capabilities 

-Use one of several ePA provider portals online that works with Express Scripts (such as Surescripts, covermymeds or ExpressPAth) 

-Submit traditional paper prior authorization request forms to Express Scripts by fax 

Express Scripts states on their website that over 60% of providers submit ePA requests now, but that still leaves 40% of billing departments opting for paper versions. Whatever you choose, Express Scripts will require your NPI number, so have that at the ready. 

Trouble with Addiction Treatment Registration for Express Scripts? We Can Help.

BehaveHealth’s Revenue Cycle Management (RCM) service includes soup-to-nuts, hyper-detailed, hands-on attention to every single component of your addiction treatment billing needs. We have strong working relationships with every major insurance company in the United States. 

Even better, we’re not health care generalists.  We only work for behavioral health providers like you.

Let our team of specialists handle it all: 

  • Verification of Benefits 

  • Utilization Review 

  • Billing and Collections 

  • Patient Responsibility

  • Denials and Appeals 

Get your free trial started today and see why more addiction treatment centers prefer Behave Health.

Is Credentialing or Enrolling with Blue Cross Blue Shield of Michigan Worth it for Addiction Treatment Providers?

There are many pros to enrolling with BCBSM. For one, you’ll find that it is easier to attract addiction treatment patients when you are in network with BCBSM. This is huge because BCBSM is such a large payer in the area and commands such a large market share of patients.

How to Handle Utilization Reviews with Blue Shield of California for Addiction Treatment

While they’ve done things like make nominal financial contributions to the cause of diversifying the mental healthcare profession, Blue Shield of California is part of a general trend in managed care to minimize costs for insurers by limiting the scope of “medical necessity,” especially when it comes to addiction treatment.

Doing a Pre-Certification or Prior Authorization with Molina HealthCare for Addiction Treatment? Here's What You Need to Know. 

Prior authorization or precertification is required by most health insurance companies for many behavioral healthcare and addiction treatment services, and Molina Healthcare is no exception.

4 Quick Tips for Managing Addiction Treatment Discharges with Independence Blue Cross

Here’s 4 quick tips for understanding addiction treatment discharges with Independence Blue Cross.

Mastering The ASAM Criteria for Addiction Treatment is More Important Than Ever Before

Whether you refer to it as the “Six Dimensions,” The ASAM Criteria or simply a “biopsychosocial,” the ASAM Criteria has come to dominate the landscape of multidimensional assessment in the addiction treatment community.

Even Post-Pandemic, Virtual Addiction Treatment Care Will be Here to Stay

Surveys show that 2 in 3 addiction treatment providers who adopted telehealth in response to the pandemic will maintain a telehealth presence after the pandemic wanes. Why?


Stop Keeping Bed Availability at Your Addiction Treatment Center a Secret - Set up Automatic Updates Today

How do potential patients and their loved ones discover that your addiction treatment center has free beds?

Get Behave Health for Addiction Treatment Centers FREE. (Yes, Free!) 

Now you can explore Behave Health’s ridiculously useful features from the comfort of your own phone or computer with absolutely zero hassle or pressure.

VOB Delays = Addiction Treatment Admissions Killer. Turbocharge Your Insurance Verifications with eVOBs

Learn about instant VOBs — also known as eVOBs — and how they could be a game changer for your addiction treatment center.