Behavioral HealthHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingNovember 29, 2023

Claims analysis of codes billed concurrently with Residential Substance Use Disorder Treatment Center Services

Anthem Blue Cross and Blue Shield embraces opportunities to foster collaboration efforts with providers to help ensure proper coding and payment of claims. To this end, we regularly review the Indiana Health Coverage Programs Provider Reference Modules to ensure we process claims that are consistent with state guidance.

This letter is sent as a reminder that per the Indiana Health Coverage Programs Provider References Module for Behavioral Health Services, page 53 and in accordance with 405 IAC 5-20-8 (14):

  • Low-intensity (Procedure code H2034) and high-intensity (Procedure code H0010) residential substance use disorder treatment center (RTC) services that are included under the per diem payment will not be reimbursed separately for a member for the same dates of service as the per diem payment is reimbursed.
  • These bundled services (when provided by the same facility or provider) include individual therapy, group therapy, medication training and support, case management, drug testing, peer recovery support, and skills training and development.

Billing for these included services, in addition to RTC services (through the same provider for the concurrent dates of service), will result in denial of the associated claim.

We are grateful for your care of our members and look forward to continued collaboration.

Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. Independent licensee of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

Providers who are contracted with Anthem Blue Cross and Blue Shield to serve Hoosier Healthwise, Healthy Indiana Plan, and Hoosier Care Connect through an accountable care organization (ACO), participating medical group (PMG) or Independent Physician Association (IPA) are to follow guidelines and practices of the group. This includes but is not limited to authorization, covered benefits and services, and claims submittal. If you have questions, please contact your group administrator or your Anthem network representative.

INBCBS-CD-027353-23-SRS26289