Wiki Bill Type for Behavioral Health Partial Hospitalization

[pc4me1]

The billing system we use was set up by previous employees who really weren't qualified and for the bill type for behavioral health partial hospitalization, they have the 2nd digit set as 8 which is correct since we are a specialty facility but the 3rd digit they set up as 3 which is not correct because it shows as ambulatory services. My question is which would be the correct 3rd digit, 6 or 9 or is there a completely different 3rd digit that anyone uses and is accepted by the insurance companies?

Thank you!!

 

[lissaotto]

I have found that the bill type really depends on the payer. For IOP claim I typically use 1 in the 3rd digit space or 7 if it's a resubmission. For the majority of commercial claims, 871 is fine. Some Anthem, Humana, UHC plans don't like 871 and process the claims with 731. I did get a response from Anthem one time about it and they said that the 2 digit corresponds to the level of severity of the visit (for example, if I used 751 that was considered a moderate severity vs 731 was not). Which is not what I understood the 2nd digit to be!! I just keep alerts set for those plans that require a different bill type than the 871