The federal confidentiality law and regulations protect the privacy of substance use disorder (SUD) patient records by prohibiting unauthorized disclosures of patient records except in limited circumstances. Congress enacted the legislation to encourage individuals with SUDs to enter and remain in treatment. Learn more about the law commonly referred to as “Part 2”.
If a provider treats or diagnoses a patient for SUD or refers patients for treatment of SUD and is subject to the Confidentiality of Substance Use Disorder Patient Records (42 CFR Part 2) as a Part 2 Program, that provider must comply with the terms of their contract with respect to any claim or other information they submit to a health plan that contains patient identifying information. Payment of these claims is contingent upon compliance with these requirements. View a sample form (PDF) for obtaining consent.
For dates of service on or after April 1, 2020, providers must include a Part 2 disclaimer with any claim (or other record) that contains patient-identifying information when submitting the claim (or other information) to BridgeSpan.
When submitting an electronic claim (837 P or I) for Part 2 services on or after April 1, 2020, you must include the information listed below:
- On the CLM09 field, indicate an “S” for obtaining informed consent from the patient to release information governed by a federal statute. See below.
a. Note: This should be familiar with providers, as the field is general – and not specific to Part 2. - Then, under the NTE01 segment, indicate “ADD” for a narrative.
a. Note: Only one ADD is permitted per claim. - Under the NTE02 segment, include in the free-form narrative the Part 2 disclaimer language, as required by federal law. See below.
a. Note: A recent federal rule allowed a short form or long form disclaimer when Part 2 information is shared (e.g. from provider to health insurer).
Here are the two options, though the shorter version is preferable:
- Short form (Preferred version)
a. 42 CFR part 2 prohibits unauthorized disclosure of these records. - Long form
a. This record which has been disclosed to you is protected by federal confidentiality rules (42 CFR part 2). The federal rules prohibit you from making any further disclosure of this record unless further disclosure is expressly permitted by the written consent of the individual whose information is being disclosed in this record or, is otherwise permitted by 42 CFR part 2. A general authorization for the release of medical or other information is NOT sufficient for this purpose (see § 2.31). The federal rules restrict any use of the information to investigate or prosecute with regard to a crime any patient with a substance use disorder, except as provided at §§ 2.12(c)(5) and 2.65.
ANSI 837 Field | Value | Description/Notes |
|---|---|---|
CLM09 | I | Informed Consent to release Medical Information for Conditions or Diagnoses Regulated by Federal Statutes |
NTE01 | CER | Certification Narrative |
NTE02 |
| Part 2 disclaimer language, as required by federal law. BridgeSpan prefers use of the shorter disclaimer. |
To ensure accurate reimbursement, claims should include:
- Contracted per diem codes—one line per date of service (i.e. line level “from” date equals “to” date) with 1 unit of service
Hourly codes—one line per date of service (i.e., line level “from” date equals “to” date) with the total units (hours) rendered
Do not use:
- Date ranges (e.g., 01/01/2020 – 01/03/2020) on a single line
- Multiple lines with the same date of service for the same code