Medicaid Provider: Effective January 1st, 2020, Telligen will be reviewing inpatient admissions for substance use disorders treatment for medical necessity.  These services will only be payable to licensed and accredited hospitals that are qualified as Institutions for Mental Disease (IMDs) and that offer at least two types of Medication Assisted Treatment (MAT) for opioid use disorder.  These admissions for Medicaid participants will be:

  • For all ages (adolescents and adults)
  • For a primary diagnosis of Substance Use Disorder
  • For ASAM 3.7 and ASAM 4.0 level of care

The review will be due to Telligen on hospital day four (4) if the member has not been discharged.  The member is only eligible for thirty (30) inpatient days of substance use disorder treatment per rolling calendar year per CMS guidelines. No provider will be able to bill once the member has reached this allowed amount of days within the rolling year. To submit via the Telligen Qualitrac Provider Portal, please ensure the request is submitted using the following information:

  • Review Type – Acute Behavioral Health
  • Place of Service – Inpatient Psychiatric Facility
  • Type of Service – ASAM 3.7 or ASAM 4.0 

For additional information about how to submit a review using the Qualitrac Provider portal, please follow the link: For questions related to substance use disorder treatment, please contact:

Jennifer Bly
Program Manager
Email | (208) 433-7510