Billing Unit - For all billing inquiries, please contact your assigned Billing Unit Representative.  If you are uncertain as to whom your assigned representative is, please contact the Billing Manager.

Mental Health / Substance Abuse Billing Documents

Billing Manual and Billing Manual Addendum

This is an extension of all contracted treatment providers. Please be sure to read, review and disseminate to all parties that may be involved in the billing practices for your agency.

DPBHS Contracted Service Codes and Fee Schedule

Crisis Intervention, MH
Dialectical Behavioral Therapy (DBT)
Family Based Mental Health Service (FBMHS)
Family Functional Therapy (FFT)
In State Residential
Inpatient Hospital
Mental Health - Outpatient
Mental Health - Intensive Outpatient
Mental Health - Day Treatment
Multisystemic Therapy (MST)
Substance Abuse - Outpatient
Substance Abuse - Intensive Outpatient
Substance Abuse - Day Treatment
Substance Abuse – Residential Treatment (Refer to Service Certification and Reimbursement Manual)
Therapeutic Support for Families (TSF)

Billing Summary

This cover sheet MUST accompany all monthly claims for Crisis, Outpatient, Therapeutic Support for Families and all other services. The billing total on this form must equal the total on the individual Client Billing/Activity Forms.

Client Billing/Claim Form

Use this form to submit all claims for Crisis, Outpatient, Therapeutic Support for Families and all other services.

List of Place of Service Codes

A Place of Service code must be listed on all claim forms for all services.

Billing Unit Resubmission Cover Sheet

Must accompany any bill/invoice that was denied by DPBHS

Claim Inquiry Form

Must be used for any information request following up on a claim in writing

Monthly Style Billing Form - Residential and Day Treatment

This form is referenced in the DPBHS Billing Manual. It MUST be used by all unit or cost-reimbursable programs as well as providers that are not billing electronically for these levels of care

Submitted in Error Form

This form must accompany any identified claim errors submitted to DPBHS (i.e., incorrect units, dates, sub-service, or clients)

Transportation and Translation Forms

For contracted agencies that only provide Transportation and/or Translation services

Treatment Billing/Claim Level 1 Appeal Form

This form must accompany any Written Appeal addressed to the Billing Manager upon receiving denial from the reconsideration from the Billing Representative

Treatment Billing/Claim Level 2 Appeal Form

This form must accompany any appeal to the Manager of Provider Services, upon receiving denial from the Level 1 Appeal to the Billing Manager. This is the final level of appeal available for claims reimbursement.