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Critical Access Hospital Type of Bill Code Requirements
Effective date
Not stated in the notice
Identified
Oct 15, 2026
Summary
Ambetter of Alabama is requiring Critical Access Hospital (CAH) providers to submit claims using specific Type of Bill (TOB) codes based on service type: 11X for inpatient, 85X for outpatient, 14X for laboratory, and 18X for swing bed services. Claims submitted with incorrect TOB codes will be denied and require resubmission.
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What to do
Action · 3 steps
01Billing team and CAH provider partners should review current claim submission practices and update billing systems to enforce correct Type of Bill code selection based on service rendered (11X for inpatient hospital services, 85X for outpatient hospital services, 14X for laboratory services, 18X for swing bed services).
02Verify that all CAH facilities contracted with Ambetter of Alabama are submitting claims with the appropriate TOB codes to avoid claim denials and resubmission requirements.
03Consult the Ambetter of Alabama Provider Manual for additional detail and contact Provider Relations or Provider Services for implementation assistance.
Original notice
Critical Access Hospital Type of Bill Code Requirements
ambetterhealth.com · Always check the source before changing claims.