Verification of benefits, ASAM-aligned documentation, and utilization review, built for RTC, PHP, IOP, and MAT providers. HelloMDs supports addiction medicine providers with billing built for today’s payer requirements.
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A single missed prior authorization can turn a 30-day residential stay into 30 days of unpaid care. Addiction medicine billing involves more moving parts than almost any other specialty: verification of benefits before a bed opens, ASAM-backed authorizations that renew every few days, MAT and toxicology codes that payers love to flag, and telehealth prescribing rules that keep shifting amid DEA extensions.
HelloMDs runs addiction medicine billing services for residential, detox, PHP, IOP, sober living, and MAT programs nationwide, backed by a 99% first-pass claim rate and AAPC-certified coders who read ASAM criteria the way your clinical team does, line by line, not as a checkbox.
Four problems account for most of the denied or delayed revenue we see when a new SUD program comes to us.
VOB Bottlenecks - Admissions teams verify benefits by hand while a bed sits empty, and one missed exclusion turns into a self-pay write-off.
ASAM Reauthorization Cycles - Residential and PHP stays need concurrent review every three to seven days, and one late reauthorization can end coverage mid-treatment.
MAT & Toxicology Coding - Sublocade, Vivitrol, and same-day presumptive-plus-definitive drug testing trip payer edits that strip the second claim automatically.
Algorithm-First Denials - Payers increasingly run prior authorizations through AI review first, and a denial now needs a human reviewer's signature in a growing number of states.
Five areas cover most of what decides whether an SUD claim gets paid the first time.
We verify benefits and flag lifetime SUD-treatment caps or out-of-network penalties before your admissions team commits a bed, not after.
Concurrent reviews go out on the payer's clock, typically every three to seven days for H0018/H0019 residential stays, mapped to ASAM dimensions.
Q9991/Q9992 for Sublocade, J2315 for Vivitrol, G2086-G2088 for office-based OUD bundles versus the separate weekly codes an OTP uses instead.
One presumptive code (80305-80307) and one definitive code (G0480-G0483) per patient, per day, filed so payer edits don't strip the second test.
Commercial, Medicaid, and OTP-specific payer enrollment handled start to finish, so a new counselor or location doesn't sit unbillable for sixty days.
Every claim runs through coders certified in behavioral health and SUD-specific coding, not general practice billing staff learning the specialty as they go.
Fifteen-plus years of combined revenue cycle work means payer-specific quirks get caught before a claim goes out, not after it’s denied.
A single team stays assigned to your account and learns your program’s ASAM documentation style instead of rotating between unrelated specialties.
Claim data and SUD records move through systems built for HIPAA and the newly enforced 42 CFR Part 2 rules together, not bolted on after.
Denial rates, AR aging, and first-pass ratios stay visible in a live dashboard instead of a monthly recap you have to request.
01
Clean, ASAM-backed claims mean fewer first-pass rejections and less staff time rebuilding the same claim twice.
02
VOB and eligibility checks happen before intake, so the payment clock starts on day one, not day thirty.
03
Documentation matched to the exact H-code or G-code billed holds up when a payer requests records.
04
Credentialing across commercial, Medicaid, and OTP-specific payers opens more admissions without new staff.
05
Real-time reporting on claim status and AR aging replaces guesswork with a number you can plan around.
| Where It Breaks | How We Fix It |
|---|---|
| VOB comes back wrong | We recheck lifetime SUD caps and network status against the payer portal before the bed is confirmed. |
| Residential stay denied mid-treatment | Concurrent review notes go out before the reauthorization deadline, mapped to ASAM dimensions. |
| MAT injectable claim rejected | Q9991 vs. Q9992 and J2315 get matched to the actual dose, with prior auth on file first. |
| Toxicology claim underpaid | Presumptive and definitive codes go on separate, medically necessary claims so edits don't zero out the second test. |
| Out-of-network payment sent to the patient | We pursue single-case agreements and direct payer contact so the check lands with you, not the patient. |
| Parity-based denial on a level-of-care request | Appeals cite the payer's own medical/surgical comparison, the leverage MHPAEA gives providers under extra scrutiny. |
The feedback and experiences shared by our clients inspire us to continually improve, innovate, and deliver smarter solutions. Here’s what healthcare professionals are saying about their experience with Hello MDs and why you can trust on us by knowing their experiences.
Your admissions team already knows which claims stall. Send HelloMDs your last quarter’s denial report and see exactly where addiction medicine billing services close the gap. Free, no obligation.
Three things stand out: telehealth prescribing for buprenorphine is now a permanent rule instead of an annual extension, broader MAT telehealth flexibilities run through December 2026, and a growing number of states now require a human reviewer before an AI-flagged medical-necessity denial can stand.
Match the code to the documented level of care: H0015 for IOP, H0018/H0019 for residential, H0035 for PHP, and verify benefits before admission, not during it. Most rejected claims trace back to a documentation-to-code mismatch, not a difficult payer.
Yes. Group and individual sessions use separate codes, and a group note has to reflect one patient's participation and clinical progress, not just attendance. A roster alone gets denied as insufficient documentation.
Expired prior authorizations, a level-of-care mismatch between the code billed and the chart, same-day toxicology billing errors, and lapsed payer credentialing account for most denials nationally in 2026.
Significantly. Medicaid, Medicare, and commercial plans set different rates for the same H-code or G-code, and in-network versus out-of-network status decides who the check gets sent to, you or the patient.
Yes, through two separate code families: opioid treatment program bundles (G2067-G2072) for licensed OTPs and office-based MAT bundles (G2086-G2088) for other settings. Each requires its own credentialing before you can bill Medicare for it.
