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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.
| Challenges | How We Handle it |
|---|---|
| Same-or-similar denials | We document prior equipment history and changed medical needs before the claim goes out, not after a denial arrives. |
| Missing written orders | A valid Standard Written Order gets confirmed on file before submission, every time. |
| Prior auth delays | Dedicated staff submit and follow up on requests directly with the payer instead of waiting for a portal update. |
| CPAP/oxygen reauthorization | Compliance windows and recertification deadlines get tracked, so rental payments continue without a gap. |
| Medicare Advantage rule variance | Coders check each plan's specific coverage criteria instead of applying traditional Medicare rules by default. |
| Slow reimbursement cycles | Claims get scrubbed for errors before submission and followed up within days, not weeks. |
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.
Stop chasing denials after they happen. A free audit shows exactly where DME claims are stalling, no obligation, no long-term contract required to start.
DME billing means coding, submitting, and collecting payment for durable medical equipment, wheelchairs, CPAP machines, and oxygen equipment, using HCPCS Level II codes rather than CPT codes, submitted on a CMS-1500 form under Medicare Part B and DME MAC rules.
Most trace back to missing documentation: No Standard Written Order on file, medical necessity notes that don't match the HCPCS code billed, or a same-or-similar item already on record. Expired prior authorizations and lapsed rental recertification cause most of the rest.
Yes, for items on CMS's Required Prior Authorization List, expanded to 74 HCPCS codes in April 2026, including power wheelchairs and certain orthoses. Suppliers with a 90%-plus affirmation rate can qualify for an exemption.
Pricing usually runs as a percentage of monthly collections rather than a flat fee, so cost tracks with what actually gets paid. HelloMDs plans start at 2.95% of collections.
