All PlansBilling CodesHigh impact
Provider Manual Update
Ambetter·IA · Psychiatry·Claims & Billing
Effective date
Aug 7, 2026
We identified it
Aug 26, 2026
Summary
Ambe Better Health has updated its Provider Manual to clarify inpatient billing requirements for Type of Bill (TOB) 86x and address variability in provider billing across inpatient (11x), residential treatment center (86x), and outpatient (13x, 76x) settings. A new BH TOB scenario document has been created to provide specific guidance on revenue and procedure code usage for each billing type.
Action Required
Immediately: Billing team must obtain and review the new BH TOB scenario document from Ambe Better Health covering inpatient (11x), RTC (86x), and outpatient (13x, 76x) billing. By August 21, 2026: Update billing system configuration and staff training to align with the clarified TOB and revenue code requirements. Audit all claims billed as TOB 86x, 11x, 13x, and 76x from the past 90 days to identify and correct any billing that does not conform to the new guidance. Failure to implement these changes may result in claim denials or recoupments for non-compliant billing.