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Type of Bill Codes

  1. Default Type of Bill Codes
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    I need help!

    Trying to figure out the proper Type of Bill Code to submit on a UB-04 claim form for a Sub-Acute Detox/Residential Substance Abuse Rehab Treatment Center (Inpatient).

    Currently, our Billing Dept is outsourced. They have been using Code 113.

    After receiving a denial on a specific claim I contacted that insurance company. I was told that our Tax ID does not reflect a hospital setting and the first digit for claim type is incorrect and should be replaced with an 8-Specialty Facility. When I contacted the Billing Dept they stated that all those claims were resubmitted with bill type 163.

    If we are not a Hospital how are they getting our claims paid as a "Hospital" setting?

    Please help!

  2. #2
    Stuart, FL Sailfish Chapter
    Its payer specific.

    Technically you cannot even classify outpatient care at a non residential facility so I have not had an issue using 11x and 13x on my claims. Every once in a while, I will get a payer like GEHA who will want the 86x code. Other payers like Magellan will only accept the 11x and 13x codes and they are specialty MH/SA. If the payer is asking for the 86x code for inpatient residential, then I will just give them what they want. I have gone through many audits, and type of bill codes have never been an issue.

    To be honest, I dont even know what 163 is for since my RCM software doesn't even give me the option. So something tells me those claims are going to deny.

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