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