NIATx Third-party Billing Guide, 2nd Edition

NIATx Third-party Billing Guide, 2nd Edition [field_org_abbreviation]

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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