Clarification: Billing Change for Inpatient MH/SA Services

Effective April 1, 2009, providers billing for inpatient and intermediate mental health/substance abuse services should note that the primary diagnosis classification (medical, psychiatric or chemical dependency) submitted on the claim must match the primary diagnosis classification on the preregistration for those services.

If the primary diagnosis classifications do not match, the claim for those services will deny and the member will not be responsible for payment.

This change applies to commercial inpatient and intermediate mental health/substance abuse facilities and is documented in the Mental Health/Substance Abuse (Inpatient and Intermediate) – Facility Payment Policy.

February 1, 2009
Updated May 1, 2009
Note: The information in this article was correct as of the date of posting and may not reflect subsequent policy changes.