BCBS billing error for substance abuse facility claim

julie@medexplus.com

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If anyone is familiar with substance abuse facility claims I have a new IOP facility that has both clients with SA dx and MH dx for out patient visits. The facility is new so only has a few clients for 90837 visits. My initial claims to BCBS for the client with a sa dx I coded 914 rev code and 90837 CPT and it is rejecting billing error?
I have other IOP facilities I bill for all the time and have no issue. If anyone has experience with this type of billing can you reach out to me (954) 696-1121

I'm wondering if it has something to do with their BCBS provider # which is 5 digit and it is tied to the medical director who is a psychiatrist.
Other IOP facilities BCBS ID"s are 3 digit

Thanks!
 

K.Elizabeth

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Just taking a shot in the dark here.. Perhaps it's the psychiatrist's taxonomy which is not jiving with 90837. Psychiatrist's provided psychotherapy are add on codes to E/M services.
Just to clarify; your using 90837 for individual SA/MH sessions and 90853 for IOP (group therapy) sessions right?
 

Cavalier40

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when it comes to BCBS, the type of bill code on UBs matters. If you are using 73X, BCBS will reject it. FEPs will deny almost everything in the 7XX family and will tell you to bill 13X.

While I have had success billing 76X, we recently changed to bill everything as 13X which has worked well.
 

julie@medexplus.com

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BCBS billing issue

Hi,

Thanks for the reply. I always bill on UB04 for these facilities and use bill type 131. Place of service is 57 the facility is out of network and the client has OON benefits
I used 914 rev code with 90837 individual session on these particular claims
UB04 has facility info tax ID, NPI and at bottom of UB04 is the rendering LCSW info but with the facility NPI and his license info. He is the owner of the facility and working under the facility NPI.

BCBS just issued some policy update this month that they are no longer accepting facility claims with the rev code 914 or 915.
My claims were in January, Feb, March still trying to figure out why they say billing error.
Another rep told me they don't like to see any rendering provider info on a UB04 claim form only the facility info? I have never had issues with my other facilities claims like this stumped..
Any ideas?
 

julie@medexplus.com

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Thanks Ben for the links.
This facility is an IOP and I know to bill with 131 and use rev code 906 with H0015 for the IOP visits but I have been able to also bill and get reimbursed for out patient visits on a UB04 claim form with 914 90837.
So this particular facility I have had trouble with and wondered if it were due to the MH diagnosis code?? The facility is licensed by DCF for SA IOP treatment but under this license the therapists can perform out patient counseling services.
 

Cavalier40

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I am having this same problem. I have a separate post about it.

It seems as if BCBS FL is no longer paying under rev codes 0914 and 0915 stating that they are professional outpatient services.

New Directions also has it in their policy manual that the group NPI should be on the 1500 form in boxes 24J and 33A. It could be the same philosophy on the UB04.

I will keep you posted if I find out anything new
 
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pc4me1

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SA Facility Charges

When billing facility charges for IOP SA, the Rev Code is 906.
 

Ajabills

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Reimbursement

I am working with a new facility, they will be doing inpatient intensive medical detoxification (drug dependency). I am trying to find an average daily reimbursement for these services. I am getting a range of $1200 to $2000 per day. Any guidance would be greatly appreciated specifically with H0011 - frustrated!!
 
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are you submitting the claims with a 3 digit provider number on the UB04 for 906, 912, and the 5 digit provider ID on the 1500 form for OP to Jacksonville?
 

npitaxid

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follow up

Does anyone know what the final official determination is for this issue now that some months have passed? Started billing again after an outside billing company had taken over for our SA facility. They were trying to set up a physicians group to correct this issue but what I was doing and getting paid on was just using 0900 revenue code on a UB04 form. Is this the appropriate way to bill these outpatient claims for BCBS?
 
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