GUIDE TO AVOIDING DENIALS FOR SUBSTANCE USE PREVENTION & RECOVERY (SUPR)
Date: 02/28/23
While reviewing claim denials for SUPR service, Meridian identified the most common billing areas for correction on denied claims and best practices for first-time claim submissions to ensure prompt and accurate payment.
For convenience, all billing guidelines for SUPR billing are in the IAMHP website.
If a claim was denied for any reason noted below, you may correct the claim and resubmit it. When correcting claims, it is essential that a resubmission code of 6 (Corrected) or 7 (Replacement) is used to indicate a corrected or replacement claim. If a claim is submitted without properly identifying it as corrected, the claim will be denied as EX18 or EX DS– Duplicate claim.
IMPACT registration and proper NPI billing
Provider billing for SUPR services may only be rendered from a site certified by the Illinois Department of Human Services (IDHS), Division of SUPR (provider Type 075). The NPI billed must be a SUPR-certified site. For CMS-1500 billing, the NPI in box 33 must be a SUPR-registered site.
If you have multiple NPIs and bill SUPR claims with an NPI that is not registered as provider type 075 Meridian will deny the claim. A denial of EX ZE- Procedure Is INAPPROPRIATE for Provider Specialty will be issued.
Providers of Medication Assisted Therapy (MAT) services must also be certified and enrolled with HFS under the Methadone Clinic Subspecialty (Category of Service 106).
Providers offering substance abuse and mental health services at the same site may not utilize the same NPI number to bill both services. Mental health services must be billed under a separate NPI number.
Diagnosis Codes
SUPR claims require a diagnosis in the range of F10-F19.99. Claims submitted to Meridian for SUPR services and a diagnosis other than F10-F19.99 will be denied as EXDU or EXI9 – Invalid Diagnosis. Claims may be corrected with the appropriate diagnosis range and resubmitted.
Modifier Billing
Claims billed with invalid modifiers will be denied with EXIM – Invalid or missing modifier. The allowed modifiers are listed below.
H0004, H0005 – no modifier, TF, GT, or 93
H0006, H0012, H2014, H0047 – no modifier, HA, GT, or 93
All other codes do not require a modifier. When billing telehealth services, only modifier GT or 93 are acceptable. Modifier 95 is not allowed per HFS billing guidelines.
When billing for telehealth services, claims billed with modifiers 93 or GT must also be billed in a place of service (POS) 02 or 10. Claims that are billed with an invalid telehealth and modifier combination will be denied based on the following:
EXVT – Missing/Invalid telehealth modifier (billed POS 02 or 10 but did not bill a modifier)
EXHU – Invalid telehealth location (POS is other than 02 or 10 billed with 93 or GT)
Place of Service
| Allowed POS for SUPR billing | |
|---|---|
| 55: Residential substance abuse treatment facility | 57: Non-residential substance abuse treatment facility |
| 02: Telehealth provided in other than in patient’s home | 10: Telehealth provided in the patient’s home |
| 03: School | 21: Inpatient |
| 22: Outpatient | 99: Other |
Medication Assisted Treatment- billed with a MAT NPI
11: Office
55: Non-residential Opioid Treatment Facility
Claims billed for any other POS will be denied with EX4B – Invalid place of service billed. POS may be corrected, and the claim resubmitted for processing.
Type of Bill, Admission Dates, Revenue Codes, Interim, and Per Diem Billing
For SUPR claims billed at the facility level, please keep the following in mind:
Type of Bill: All SUPR claims should be billed with TOB 861-864, 891-894 or 867/897. Claims billed with other TOB will be denied as EX BG – Invalid bill type.
Admission Dates
Please refer to the IAMHP manual interim billing guidelines for more details on admission dates on interim claims. The most common error is the admission date does not match the statement date. Claims that are not billed following the date of admission guidelines will be denied as EXFe – Missing/Invalid admit date.
Revenue Codes
SUPR claims billed on a UB04 claims form must be billed with revenue code 944 or 945. Claims billed without a revenue code or with any revenue codes other than 944 or 945 will receive a denial of EXR9- Invalid rev code.
Per Diem Billing
Claims must be billed with one line for SUPR services with the appropriate number of days indicated. Claims billed with multiple lines for multiple days will be denied as EXB6 – Improper billing of Per Diem
Questions?
Please login to the secure provider portal for updated claims information. You may also call Provider Services at 866-606-3700, or contact Provider Relations via email at: bhpr@centene.com.
This notice is applicable to Meridian Medicaid Plan, Meridian Medicare-Medicaid Plan and YouthCare HealthChoice Illinois.