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Addiction and substance use treatment programs

Substance Use Treatment Billing at Every Level of Care

Medtransic bills insurance for substance use treatment programs at every level of care they provide: outpatient, intensive outpatient (IOP), partial hospitalization or high-intensity outpatient (PHP), residential and inpatient care, including withdrawal management. We bill whatever your clinicians bill. That includes verifying benefits before admission, getting authorizations, keeping up with concurrent review, and following up on every claim. Billing is 4-8% of what we collect for you, and credentialing is $150 per application, per provider. There is no long-term contract.

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Every level of care we bill

Illustrative

  1. Medically managed inpatient

    Hospital-level care

    Level 4

  2. Residential

    Usually a daily rate after authorization

    Level 3

  3. High-intensity outpatient (PHP)

    20 or more hours a week

    Level 2.5

  4. Intensive outpatient (IOP)

    9 to 19 hours a week for adults

    Level 2.1

  5. Outpatient

    Usually billed per session

    Level 1
ASAM 4th edition levels, most intensive on top; withdrawal management is part of care at each level.
Billing
4-8%
of what we collect for you
Credentialing
$150
per application, per provider
Contract
None
no long-term contract
Software
Qualifacts
or the system you already use

Where treatment programs lose money

Most lost revenue is lost before the claim is sent: at admission, authorization or review.

Admissions without a clear benefits check

Without a benefits check before admission, a program can deliver days of care the plan does not cover at that level, or covers far less than expected.

Days delivered past the authorization

Payers approve a set number of days, and extending needs updated clinical notes before they run out. A missed review means care keeps going while payment stops.

The wrong claim for the level of care

Residential and day programs are usually paid a daily rate on a facility claim; outpatient therapy is billed per session. Mixing them up gets claims rejected.

Records handled without Part 2 privacy rules

42 CFR Part 2 gives substance use treatment records extra protection. Programs had to follow the 2024 update by February 16, 2026, including in records requests and appeals.

What we run, and what stays with you

Medtransic runs

  • Benefits verification before admission, for the level of care planned
  • Initial authorizations and concurrent review follow-up
  • Facility and professional claims for each level of care
  • Payment posting and underpayment checks
  • Denials, appeals and A/R follow-up
  • Credentialing for the program's clinicians

Your practice keeps

  • Clinical decisions, placement and treatment plans
  • Clinical documentation the reviewers ask for
  • Your EHR, your licenses and your admissions team
  • Patient financial policies

Every level of care, billed the way payers expect it

Levels follow the ASAM Criteria, 4th edition (2023), and we match payers still using 3rd edition names. Withdrawal management is now part of care at each level.

  1. 01

    Level 1

    Care
    Outpatient
    What it involves
    Individual, group and family sessions
    How it is usually paid
    Per session, after checking benefits and session limits
  2. 02

    Level 2.1

    Care
    Intensive outpatient
    What it involves
    Usually 9 to 19 hours a week for adults; Medicare requires at least 9
    How it is usually paid
    A set period, reviewed again before more is approved
  3. 03

    Level 2.5

    Care
    High-intensity outpatient, formerly partial hospitalization
    What it involves
    A day program with 20 or more hours a week
    How it is usually paid
    Medicare pays a daily rate, higher on days with four or more services
  4. 04

    Level 3

    Care
    Residential
    What it involves
    Treatment in a licensed facility
    How it is usually paid
    Daily rate after authorization, with concurrent review to continue
  5. 05

    Level 4

    Care
    Medically managed inpatient
    What it involves
    Hospital-level care
    How it is usually paid
    Clear medical necessity and quick authorization at admission
  6. 06

    Opioid treatment

    Care
    Medication for opioid use disorder
    What it involves
    Medication such as methadone or buprenorphine, plus counseling
    How it is usually paid
    Medicare: weekly bundle to SAMHSA certified, accredited programs; monthly bundle for office-based care

Getting the program and its clinicians in network

Payers check the program's licensing and accreditation first, then enroll the facility and its clinicians.

  1. 1

    Program license and accreditation

    A state license for each level of care; for IOP, PHP and residential networks, Evernorth also asks for accreditation or Medicare certification.

  2. 2

    Facility enrollment

    The program enrolls with each payer as a facility, often with separate approval for each level of care.

  3. 3

    Clinician credentialing

    Physicians, nurse practitioners and licensed counselors who bill under their own names are credentialed individually, starting with a complete CAQH profile.

  4. 4

    Counselors in Medicare

    Addiction counselors who meet Medicare's mental health counselor requirements can enroll in Medicare as mental health counselors.

  5. 5

    Tracked to an effective date

    We follow each application until approval and record effective dates in your client portal.

Payer notes for treatment programs

Behavioral health networks run separately

Many plans hand substance use treatment to a separate behavioral health company. Authorization, review and payment often all go through it, not the company on the card.

Medicaid varies by state

Medicaid coverage for substance use treatment, and which levels of care it pays for, varies by state and by managed care plan.

Part 2 consent under the 2024 update

Patients can now sign one consent for treatment, payment and operations, and breach notice and penalties follow HIPAA. Counseling notes kept separately need their own consent.

Your client portal, included

Your EHR shows what you billed. Your portal shows what we are doing about it.

Your EHR or practice management system runs your practice, but it does not show you our work. The Medtransic HIPAA Compliant Portal does: every claim and its current stage, the denials we are working, your A/R by age, each payer application and its in-network date, and the documents we still need from you. It is the same record our team works from, and it comes with every client account.

Did that claim get paid?
Every claim with its stage and amount, the denials we're working, and your receivables by age.
Where is my application with Aetna?
Each payer application shows its stage, its history, and the date you can start seeing that payer's patients.
What do you still need from me?
One list of the documents we're waiting on. Upload once, and it reaches every payer that asked for it.
See the client portal →
The billing screen in the Medtransic client portal: totals billed, paid, adjusted and outstanding, a twelve-month chart and A/R by age.
The billing screen. Shown with sample data. It works in any browser, on your desk or your phone. iPhone and Android apps are coming soon.

When we are not the right fit

  • If your program is entirely self-pay or grant-funded and does not bill insurance, you do not need a billing company.
  • Admissions and clinical utilization review are clinical work your team keeps. We work alongside it on billing and authorizations.

Questions substance use treatment practices ask us

Do you bill residential and PHP, or only outpatient?

We bill every level of care your program provides: outpatient, IOP, PHP or high-intensity outpatient, residential and inpatient, including withdrawal management. We bill whatever your clinicians bill.

Do you handle authorizations and concurrent review?

Yes. We verify benefits before admission, get the first authorization and keep the review calendar, so care does not run past what the payer approved.

Which systems do you work in?

We work in Qualifacts and other systems programs use, inside your existing account. Tell us what you use and we will confirm.

How much does substance use treatment billing cost?

Billing is 4-8% of what we collect for you, with no long-term contract. The consultation before you sign is free.

Has the Part 2 privacy rule changed?

Yes. The 2024 update aligned much of Part 2 with HIPAA, including a single consent for treatment, payment and operations. Programs had to comply by February 16, 2026.

Keep reading

+ Sources: 12 checked 2026-10-03

Book a free consultation

We look at a sample of your actual claims and show you, line by line, where money is going uncollected. No commitment follows it.

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HIPAA Compliant & SecureDedicated Account ManagerNo Long-Term Contract