Inpatient Mental Health/Substance Use Disorder Clarification
The Employees Group Insurance Division (EGID) would like to clarify the reimbursement methodology of inpatient mental health/substance use disorder facilities for charges incurred on or after Aug. 1, 2014. The clarification is for HealthChoice and the Department of Corrections Network Facilities and for non-Network facilities. To assist you in determining your Per Diem or MS-DRG fee schedule logic, follow the key indicators in the decision tree below:
- Is the facility licensed as a psychiatric facility?
- If YES, the facility is subject to the Per Diem fee schedule.
- If NO, the following logic applies:
- If you bill with Revenue Code 0xx4, 0xx6 or 0xx8 with a mental health/substance use disorder diagnosis, the facility is subject to the Per Diem fee schedule.
- If you bill with all other Revenue Codes (excluding 0xx4, 0xx6 and 0xx8) the facility is subject to the MS-DRG fee schedule.
- If you bill with Revenue Code 0xx4, 0xx6 or 0xx8 for diagnosis codes other than mental health/substance use disorder, the facility is subject to the MS-DRG fee schedule.
If you have further questions, please do not hesitate to contact our health and dental claims administrator by calling 1-405-416-1800 or toll-free 1-800-782-5218.