Insurance Billing

How to Turn Your Group Practice Into an Addiction Treatment Outpatient IOP or PHP in Illinois

If you’re thinking of launching an outpatient program at your group practice in Illinois - whether that’s an IOP or a PHP style program - congratulations!

Answers to Your Top Questions About Addiction Treatment Billing in Illinois

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.

Your Complete Addiction Treatment Billing Guide to New York 

If you’re operating in New York, it’s important to understand the complex billing landscape and know how to leverage the state’s increasingly stringent regulations to optimize your revenue cycle.

Your Complete Guide to Addiction Treatment Insurance Billing in Florida

Learn the basics of addiction treatment medical billing in Florida and examine the most relevant legislation and regulations for the behavioral health community in the Sunshine State.

What Are the Most Used Addiction Treatment CPT Codes in Texas?

The most common CPT codes used in Texas addiction treatment programs also happen to be the most common addiction treatment CPT codes used in the rest of the country. They are: H0001HF, H0004HF, and 96164HF.

Our Top 5 Tips for Addiction Treatment Insurance Billing in California

Struggling to keep up with all the different requirements and tricks involved with addiction treatment insurance billing in California?

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

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.

Looking for the Expedited Appeal Line for Anthem, Inc. Addiction Recovery Claims?

So you need to file an appeal on a claim decision from Anthem, Inc at your addiction treatment or behavioral health center but you’re not sure where to find the contact information necessary to do so?

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.

What Reviews are Required for Addiction Treatment Providers Under Blue Cross Blue Shield of Tennessee?

Today, we’ll examine what utilization management reviews are required of addiction treatment providers working with Blue Cross Blue Shield of Tennessee plans.

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.

Understanding CareSource Management Group's Shareable Client Information Policies for Addiction Treatment 

Today, we’ll look specifically at how CareSource Management Group treats PHI, what their shareable client information policies are and how they affect addiction treatment providers.

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 Insurance Registration with Florida Blue for Addiction Treatment Centers

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

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.