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.

Last reviewed 2026-10-03.

Where treatment programs lose money

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

  1. Admissions without a clear benefits check

    If benefits are not verified before admission, the program can deliver days of care that the plan does not cover at that level, or covers far less than expected.

  2. Days delivered past the authorization

    Payers usually approve a set number of days at first. To extend the stay, the program has to send updated clinical notes for review before the approved days run out. A missed review means care keeps going while payment stops.

  3. The wrong claim for the level of care

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

  4. Records handled without the extra privacy rules

    Federal rules (42 CFR Part 2) give substance use treatment records extra privacy protection. The 2024 update had to be followed by February 16, 2026, and records requests and appeals have to respect it.

What we run, and what stays with you

What we run

What stays with you

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.

It works in any browser, on your desk or your phone. iPhone and Android apps are coming soon. See the client portal.

Every level of care, billed the way payers expect it

Levels below follow the current ASAM Criteria (4th edition, released in 2023). Some states and payers still use the older 3rd edition names, so we match each payer's terms.

Outpatient (Level 1). Individual, group and family sessions, usually billed per session. Benefits and session limits are checked before the first visit.

Intensive outpatient (Level 2.1). For adults this usually means 9 to 19 hours of treatment a week. Medicare's intensive outpatient benefit requires at least 9 hours a week. Payers approve a set period and review it again before approving more.

High-intensity outpatient, formerly partial hospitalization (Level 2.5). A day program with 20 or more hours of treatment a week. Medicare pays these programs a daily rate, and the rate is higher on days with four or more services. Medically managed intensive outpatient (Level 2.7) is the medical tier of Level 2.

Residential (Level 3). Treatment in a licensed facility, usually paid a daily rate after authorization, with concurrent review to continue the stay.

Medically managed inpatient (Level 4). Hospital-level care, where payers expect clear medical necessity and quick authorization at admission.

Withdrawal management. In the 4th edition, withdrawal management is no longer a separate level. It is part of the care at each level, and we bill it the way each payer defines it.

Medication for opioid use disorder. Medicare pays opioid treatment programs a weekly bundled rate that covers medication, such as methadone or buprenorphine, plus counseling. These programs must be SAMHSA certified and accredited. Medicare also pays office-based practices a monthly bundle for opioid use disorder care.

Getting the program and its clinicians in network

Treatment programs usually need both the facility and the individual clinicians enrolled. Payers check the program's licensing and accreditation first.

  1. Program license and accreditation

    A state license for each level of care. For residential, PHP and IOP networks, payers such as Evernorth also ask for behavioral health accreditation (for example Joint Commission or CARF) or Medicare certification.

  2. Facility enrollment

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

  3. Clinician credentialing

    Physicians, nurse practitioners and licensed counselors who bill under their own names are credentialed individually, starting with a complete CAQH Provider Data Portal profile. Addiction counselors who meet Medicare's mental health counselor requirements can enroll in Medicare as mental health counselors.

  4. Applications tracked to an effective date

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

Clinician credentialing is $150 per application, per provider. In our experience it usually takes 60 to 90 days with each payer.

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. Breach notice and penalties follow HIPAA, patients can complain directly to HHS, and counseling notes kept separately need their own consent. Records do not have to be kept separately.

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.

If you need someone to run admissions or clinical utilization review for you, that is clinical work your team keeps. We work alongside it on the billing and authorization side.

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 revenue audit 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.

Sources

Outside facts on this page were checked against these sources on the date shown.

Related pages

Book a free revenue audit

We look at a sample of your actual claims and show you, line by line, where money is going uncollected. No commitment follows it. Call (888) 777-0860 or book a free revenue audit.