NIATx Third-party Billing Guide, 2nd Edition

NIATx Third-party Billing Guide, 2nd Edition

June 2011
University of Wisconsin-Madison
NIATX Third Party Billing Guide

Guide to help substance abuse treatment agencies increase their capacity to bill health insurance and Medicaid plans for their services as an increasing number of clients obtain public and private health insurance coverage under the Affordable Care Act (ACA).

While specific to substance abuse services, the guide outlines fundamentals to third party billing that may apply to other agencies, like:

  • Things to do before getting started (e.g., secure a National Provider Identifier (NPI) number, obtain third party payer forms).
  • Conduct a pilot test (1. Verify coverage, 2. Request prior authorization, 3. document authorization limits, 4. provide services, 5. Record service provided and bill for appropriate amount) and follow-up based upon whether payment was received (6. Collections: Bill paid or denied, 7. Monitor receivables: Follow up with the third-party payer, 8. Make corrections and resubmit bill).
  • Create a billing system (a series of questions reflecting the same steps in the above pilot, including: Which of Your Services are Billable?, Who does What?, Steps in the Billing Process)
  • Setting up a billing system (with a billing vendor or an internal system, with information on coding)
  • Taking It to the Next Level (e.g., setting goals, Billing as Part of Electronic Health Records).
  • Sample forms (e.g., Billing Policy & Financial Agreement, Sample Daily Charges Form, Sample Fee Schedule).
  • Case studies.

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