Back to Insights and Updates for ProvidersAugust 2023

Claims filing requirement for court-ordered service

Tufts Health RITogether

For RITogether members, Tufts Health Plan will not require prior authorization for claims for court-ordered mental health/substance abuse services, for dates of service beginning July 1, 2023.

To ensure appropriate reimbursement for court-ordered mental health/substance use services, it’s necessary to bill with an H9 modifier to designate that the service is court ordered. In some cases, providers could be required to present the court order to avoid post-claim payment retractions.

For further details, refer to the Inpatient and Intermediate/Diversionary Behavioral Health (Mental Health & Substance Use Disorder) Facility Payment Policy and the Outpatient Behavioral Health (Mental Health & Substance Use Disorder) Professional Payment Policy.

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