All PlansAdministrativeMedium impact
Billing for short-term behavioral health inpatient stays
Harvard Pilgrim Health Care·MA · Psychiatry·Reimbursement
We identified it
Jun 20, 2026
Summary
Point32Health (Harvard Pilgrim) updated billing guidelines for short-term behavioral health inpatient stays under 30 days. Key changes include prohibiting interim bills for stays under 30 days, requiring bill type 111 for all stays 1-30 days, and specific date field requirements including distinct admission/discharge dates for one-day stays.
Action Required
Immediately: Billing team must update behavioral health inpatient billing procedures to use bill type 111 for all stays 1-30 days. Stop submitting interim bills for BH stays under 30 days. Configure system to require distinct 'From' and 'Through' dates for one-day stays and ensure discharge status codes are used. Update staff training on MassHealth guidelines for not counting discharge date as covered day.