Critical Access Hospital Type of Bill Code Requirements

Fecha: 14/10/26

Ambetter of Tennessee is providing information regarding the billing requirements for any facility contracted with Ambetter of Tennessee as a Critical Access Hospital (CAH).

All facilities contracted as Critical Access Hospitals must submit claims using the appropriate Type of Bill (TOB) based on the services rendered. Claims submitted with an incorrect TOB will be denied and require correction and resubmission. The allowable CAH bill types are 11X, 85X, 14X, and 18X, based on the applicable service provided.

Please submit claims using the following Type of Bill designations.

Ambetter of Tennessee encourages CAH providers to review their claim submission practices and make any necessary system updates to avoid disruptions in claims adjudication.

For additional information regarding this claim submission requirement, please review the applicable Ambetter of Tennessee Provider Manual. If you have questions, contact your Ambetter of Tennessee Provider Relations Representative or Provider Services team for assistance.

Thank you for your continued partnership and commitment to serving our members.