Wiki Type of Bill Codes

[Denise@lbimg.com]

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!

 

[Cavalier40]

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.