Medicare AdvantageAdministrativeMedium impact
Important information for Substance Use Disorder Residential Treatment Providers
Blue Cross Blue Shield of Rhode Island·RI · Psychiatry·Behavioral Health
Effective date
Dec 1, 2023
We identified it
Jun 19, 2026
Summary
Providers can now directly bill Medicaid fee-for-service for substance use disorder residential treatment when patients have Blue RI Medicare Advantage Dual plans, without requiring a Medicare Advantage denial first. This applies to three specific counseling and assessment codes.
Action Required
Immediately: Billing team must update procedures to bill Medicaid fee-for-service directly for codes H0001, H0004, and H0005 when patients have Blue RI Medicare Advantage Dual plans. Stop requiring Medicare Advantage denial letters before submitting these claims to Medicaid. Update billing system rules and train staff on new workflow.