Chemical Dependency

PrimeWest Health covers chemical dependency (CD) treatment for our members. Members must have a Rule 25 Assessment performed by a qualified CD assessor from their county of residence or tribe before getting services. The CD assessor will determine the type of CD treatment members need.

For a member to receive treatment, the assessor must first complete a Client Placement Authorization (CPA) and a Rule 25 Assessment and Placement Summary form and fax these forms to PrimeWest Health. PrimeWest Health will then open a Service Authorization and create a Service Notification letter, which will be sent to the treatment facility designated by the assessor. To ensure prompt payment, the Service Notification letter should be reviewed to verify that the dates, units, National Provider Identifier (NPI), and site are correct so billing claims match PrimeWest Health's authorization.

CD providers may find the following resources helpful:

• Rule 25 Assessment tool
• Client Placement Authorization (CPA) tool
• Rule 25 Assessment and Placement Summary tool
• PrimeWest Health CD Coding Structure (effective July 1, 2011)