ghaug1973@gmail.com
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I am getting ready to start billing for Residential Substance abuse PHP and IOP as well as primary mental health PHP and IOP. I am pretty new at this. Currently it is being outsourced. Ambetter of Georgia - ACA plans (not Medicaid). Anyone have an idea of their preferred bill types for residential/PHP/IOP? For RTC the bill type currently being used is 861 and this has worked well for Admit through Discharge. For PHP the billing co has been using 89X - I don't know why they are using 9 rather than 6. We recently started getting denials for this bill type, although many of them are still processing and paying. Some of the Ambetter reps have sent the claim back for reprocessing because the other claims have paid with 89x TOB - I know of one that paid after being sent back. Other reps have refused to send claims back saying it is incorrect and either appeal or send a CC. One claim was recently sent back as corrected with a TOB of 137 and it processed and paid. Just looking for some clarity on if I need to change the TOB or continue billing with 89x for PHP and hope for the best.