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Everything you need to know to submit your claims and get reimbursed properly for your services. 

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Drug and Alcohol Billing

Inpatient and outpatient drug and alcohol billing is entirely different than most medical billing.  If the clinic is credentialed as a facility insurance claims must be submitted on UB04 claim forms rather than the more common CMS 1500 forms.

Now available - We can submit your inpatient rehabilitation claim to your insurance company in your behalf.  Insurance companies often require the claim be submitted on a UB04 form.    

Many drug and alcohol facilities do not participate with insurance companies because the billing is so different than most billers are accustomed to.  As with most of the specialties, most clients would prefer go to a participating provider over a non-par one. 

If the clinic is listed under the provider and not a facility, you must bill on a CMS 1500 when doing drug and alcohol rehab billing.  The best way to know which form you should be billing on is to call each individual insurance company you participate with and ask if you are listed as a facility or a professional provider.

The problem with billing on the wrong form is that many insurance carriers will deny a claim if it is not billed correctly.  If you participate with an insurance company as a drug and alcohol facility and bill on a CMS 1500 form your claims will most likely be denied.  If you are having difficulty getting your drug and alcohol rehab claims paid, we can help. We specialize in this type of billing. You can contact Michele or Alice at 1-800-490-4299.  

Completing the UB04 forms can be a challenge for anyone who has billed only on CMS 1500 forms.  There are several requirements you don't see on CMS forms.  Rev codes, value codes, and type of bill are required on the UB04 form.  Here is more information on completing a UB04 form completely and correctly.

In New York State you cannot counsel clients for drug and alcohol addiction except at a licensed Oasis facility.  You can treat a patient for depression who has a drug or alcohol problem, but all drug and alcohol treatment must be done at an Oasis licensed facility. 

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