insurance billing

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Part 7 of 7: Elevance Health Addiction Treatment Coverage: A Comprehensive Guide for Treatment Providers

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This in-depth pillar article empowers rehab centers and behavioral health providers by demystifying Elevance Health’s insurance coverage for substance abuse treatment. Discover expert tips on benefit verification, ASAM guideline compliance, prior authorizations, concurrent reviews, and accurate billing & coding—all designed to enhance reimbursement and streamline administrative processes.

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Part 6 of 7: Health Care Service Corporation (HCSC): Medical Necessity Criteria for Addiction Treatment

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Explore our in-depth guide on HCSC’s Blue Cross Blue Shield plans as they embrace ASAM 4.0 for adult substance use disorder treatment. This post covers critical aspects including detox protocols, inpatient/residential rehab, outpatient services (PHP/IOP), medication-assisted treatment, and billing/coding insights. Stay informed on state mandates and provider best practices to ensure compliance and optimal patient care.

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Part 5 of 7: Kaiser Permanente: Medical Necessity Criteria for Addiction Treatment Services

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Discover how Kaiser Permanente integrates addiction treatment services using ASAM Criteria to determine medical necessity. This guide covers everything from detox and residential rehab to outpatient programs and MAT, including key insights on billing codes, authorization processes, and provider collaboration.

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Part 3 of 7: CVS Health (Aetna): Medical Necessity Criteria for Addiction Treatment Services

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In Part 3 of our 7-part series, we detail CVS Health’s Aetna guidelines for addiction treatment services. This post breaks down key elements—from detox and inpatient rehab to PHP/IOP and MAT—highlighting the use of ASAM Criteria, precertification protocols, and essential billing codes to ensure medical necessity and optimal reimbursement.

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Comprehensive Eating Disorder Treatment Planning for Behavioral Health Professionals

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Eating disorders are among the most challenging conditions in mental health – not only because of their complex clinical presentation and high mortality rate, but also due to the myriad compliance and reimbursement hurdles that providers face.

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Mastering IOP Billing: CPT Codes, Insurance Reimbursement, and Licensing

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What is IOP Billing and How Does It Work? IOP (Intensive Outpatient Program) billing involves using HCPCS codes like H0015 (substance use IOP) and S9480 (mental health IOP) to submit claims for bundled daily services. Most insurers require pre-authorization, condition code 92 (for Medicare), and a minimum of 9 hours of weekly treatment to qualify for reimbursement. Proper coding, medical necessity documentation, and adherence to payer guidelines help ensure claim approval and avoid denials.

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Everything You Need to Know About Insurance Billing for Addiction Treatment in Pennsylvania 

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If you’re running an addiction treatment center, IOP program or any type of behavioral health concern in Pennsylvania, you know that addiction treatment billing in Pennsylvania is anything but straightforward.

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The Biggest Insurance Billing Mistakes Addiction Treatment Providers Make in Ohio

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Addiction treatment organizations in Ohio are most likely to run across plans issued by Medical Mutual of Ohio, Anthem Blue Cross and Blue Shield in Ohio, Aetna Inc, United HealthCare of Ohio, Caresource Management Group, Molina Healthcare Inc, Buckeye Community Health Plan and Paramount Advantage.

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Answers to Your Top Questions About Addiction Treatment Billing in Illinois

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So, you’ve How to Open an Addiction Treatment Center in Illinois and now you’ve got questions about insurance billing in the state. Billing in Illinois is complicated, but it doesn’t have to be a mystery.

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Denial Rates for Addiction Treatment with Centene Corporation (With Level of Care Breakdown!)

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Here’s what the actual rates of denial are with Centene when it comes to behavioral health. We’ll also look at what levels of care are most likely to be denied at Centene and why.

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

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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.

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

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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.

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How to Complete Insurance Registration with Florida Blue for Addiction Treatment Centers

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Wondering how to get your addiction treatment center started with registration and network registration for Florida Blue?

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Finding Addiction Treatment Billing Contact Information for Blue Cross Blue Shield Association Corporation

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Every state has a different BCBSA company with different addiction treatment billing contact information. To make matters even more confusing, some states have more than one BCBSA company operating within their borders!

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Guide: Cigna Billing Claims Address for Addiction Treatment

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If you’re a behavioral health provider, you probably don’t actually want a billing claims address for Cigna at all.


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Everything You Ever Wanted to Know About Aetna Precertification for Addiction Treatment Billing

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When it comes to addiction treatment, Aetna uses the terms precertification and preauthorization interchangeably. Aetna may also refer to this concept as Authorization, Certification, Prior authorization, or Pre-service utilization review .

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What Anthem Inc's Level of Care Denial Rates Mean for Your Addiction Treatment Center's Billing Department

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Who is Anthem, Inc? What are their average denial rates and how do they compare to the industry average? What levels of care are most likely to be denied by Anthem, Inc? What can your addiction treatment center do to fight back against behavioral health care denials from Anthem, Inc?

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How to Quickly Appeal a Centene Corporation Health Addiction Treatment Claim Denial Using the Expedited Appeal Line

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Understanding how to request an expedited appeal from big addiction treatment insurance providers - like Centene Corporation - is a key component to advocating for SUD patients.


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How to Determine the Medical Necessity of Addiction Treatment Services for UnitedHealth Group, Inc

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Got questions about working with addiction treatment and UnitedHealth Group Inc when determining the medical necessity (or if treatment is medically necessary)? Here’s how it works.