ExchangeBilling CodesHigh impact
Ambetter Behavioral Health Type of Bill
Ambetter·KS · Psychiatry, Palliative Care·Claims & Billing
Effective date
Aug 5, 2026
We identified it
Aug 26, 2026
Summary
Ambetter (Sunflower Health Plan in Kansas) has clarified Type of Bill (TOB) requirements for behavioral health claims to reduce denials. Residential Treatment Center services must use TOB 86X, while outpatient behavioral health services must use TOB 13X or 76X. Billing teams must ensure claims are submitted with the correct TOB codes based on the service setting.
Action Required
By August 5, 2026: Billing team must update claim submission processes to enforce correct Type of Bill (TOB) coding for all Ambetter/Sunflower Health Plan behavioral health claims. Specifically: (1) Configure billing system to require TOB 86X for Residential Treatment Center services; (2) Configure billing system to require TOB 13X or 76X for outpatient behavioral health services; (3) Update claim scrubbing rules to reject or flag claims with incorrect TOB codes before submission; (4) Audit all pending and recently denied behavioral health claims to identify and resubmit those with incorrect TOB codes. Failure to apply correct TOB codes will result in claim denials. Contact Provider Relations or call 1-844-518-9505 with questions.