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Split Billing of Inpatient Psychiatric vs. Acute Inpatient Medical Care Hospitalization Days

Some Blue Cross and Blue Shield of Alabama members have different benefit allowances for psychiatric and medical acute care inpatient hospitalization days. This is typically true for members with benefit coverage that is not subject to Mental Health Parity or members in employer groups that have elected to opt out of Parity. That is why it is very important to correctly submit claims for psychiatric and medical acute care inpatient hospitalization days.

When facility claims are processed, the primary diagnosis will determine the appropriate benefit to apply, whether medical or psychiatric. The primary diagnoses may differ on the medical and psychiatric claim since the reasons for admission will be specific to those admissions.

Split Billing Instructions

Hospitals should follow these sample billing instructions when a patient receives both psychiatric and acute inpatient medical care during the same inpatient admission.

  1. Submit the first split bill based on the patient's status at admission under a 112 type bill. For example, the facility should bill with the definitive medical diagnosis in "Form Locator 67" to trigger the correct utilization of the member's benefits and with the "Patient Status 30" in "FL 22" listed as "Still Patient." This will allow proper utilization of the member's acute inpatient medical care days for the first facility split bill. (A psychiatric diagnosis in FL 67 could be used for the initial facility split bill depending on the patient's actual definitive diagnosis.)
  2. The facility should then split bill using either a 113 or 114 type bill with the appropriate psychiatric diagnosis in FL 67 to allow proper utilization of the member's psychiatric inpatient days.

Benefit designs may vary from one contract to another. To verify benefits, refer to ProviderAccess, your practice management software, or the voice response unit (VRU).