Insurance Billing

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

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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.

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

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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.

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

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

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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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What Addiction Treatment Diagnosis Codes Should I Use for URs With Health Care Service Corporation?

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HCSC has a history of denying addiction treatment claims by using overly restrictive guidelines that contradict the APA’s clinical opinion. It’s critical that you use the correct diagnosis code for every HCSC UR.

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How to Use Humana's Clinical Guidelines for Behavioral Health in Your Addiction Treatment Center's Billing Department

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Learn what you can do at your addiction treatment center’s billing department to leverage Humana’s behavioral health clinical guidelines to maximize reimbursements.

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How to Find the Right Billing Claims Address for Addiction Treatment Patients with Cigna Health Insurance

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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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What's the Average Length of Stay Per Level of Care for Addiction Treatment Patients with Kaiser Foundation Health Plans?

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Although it is difficult to find information, especially current information, on the average length of stay Kaiser Foundation Health Plans will authorize for residential addiction treatment, there are some clues to be found in one 2018 report produced by the state of Oregon.

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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.

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Here’s How to Fix Your Substance Abuse Billing Issues

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Step #1: Realize that substance abuse billing is rigged against addiction treatment providers.

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Contingency Management is Coming. Is Your Addiction Treatment Center Ready?

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Contingency Management is a treatment modality that intermittently rewards clean time and program participation with cash or prizes. While some have moral objections to “paying an addict to get sober,” others point to the fact that, unlike a lot of treatments for meth, cocaine and stimulant abuse, Contingency Management (CM) actually works.

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Here's What Your Addiction Treatment Facility Needs to Know About ERKA in 2021

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The act targets patient brokering and other practices designed to defraud insurance companies.

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Has Your Addiction Treatment Center Nailed Outcomes Tracking Yet? Here's Why It's More Critical Than Ever

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Large-scale research for addiction treatment lags far behind research for other health conditions. As an industry, we’ve been slow to move towards standardized models for understanding and evaluating the success of our work. That’s changing now as market forces are requiring the addiction treatment to undertake objective progress monitoring and outcomes tracking as never before.

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Is It Time to Outsource Your Addiction Treatment Medical Billing?

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You’ve been curious about outsourcing your medical billing for a while, but you’ve heard it’s expensive and you’re apprehensive about hiring the work out.

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The Ultimate Addiction Treatment Medical Billing Glossary

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Working with medical billing isn’t the most exciting part of addiction treatment, but it is one of the most necessary parts of a successful business in the behavioral health field.

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Can Your Addiction Treatment Center's EHR Handle Value Based Care?

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Many health care experts are calling values based care the wave of the future. Smart players in the addiction treatment community are getting ready to embrace the change before it’s too late.