Workflow GuideSubstance Use Disorders

SUD APCM Patient Enrollment Workflow Guide

Streamline APCM enrollment for Substance Use Disorders with 42 CFR Part 2 compliance and AI-driven MAT monitoring workflows.

Enrolling patients with Substance Use Disorders into Advanced Primary Care Management (APCM) requires a delicate balance of clinical rigor and strict confidentiality. With the introduction of 2026 BHI add-on codes G0568-G0570, practices have a unique opportunity to fund the intensive monitoring required for MAT adherence and relapse prevention while maintaining 42 CFR Part 2 compliance.

The Challenge

Traditional enrollment workflows often fail SUD practices due to the high sensitivity of recovery data, the need for frequent touchpoints in early recovery, and the administrative burden of documenting 20 minutes of monthly care management for complex MAT patients.

Step-by-Step Workflow

1

Identify Eligible MAT and SUD Patients

Identify patients currently prescribed buprenorphine or naltrexone and those with active AUD/SUD diagnoses. Use EHR data to filter by last visit date to ensure they meet the established patient criteria for APCM enrollment.

Best Practices
  • Prioritize patients with co-occurring chronic pain or depression.
  • Check for recent detox discharge alerts.
Common Pitfalls
  • Excluding patients who only receive counseling without MAT.
2

Secure 42 CFR Part 2 Specific Consent

Implement a specialized consent process that meets 42 CFR Part 2 standards. This must include specific language about who can access SUD records and the purpose of the disclosure, often facilitated via secure digital signatures.

Best Practices
  • Use plain language to explain why data sharing improves care.
  • Ensure the consent form explicitly names the APCM service provider.
Common Pitfalls
  • Using a generic HIPAA consent form for SUD records.
3

Develop a Recovery-Focused Care Plan

Develop a structured chronic care plan that addresses specific SUD risks, including overdose prevention, pharmacy coordination for MAT refills, and triggers for co-occurring anxiety or depression.

Best Practices
  • Include naloxone access and training in the plan.
  • Coordinate with local peer support specialists.
Common Pitfalls
  • Failing to update the care plan after a relapse incident.
4

Deploy AI-Driven Adherence Monitoring

Deploy AI call handling to conduct weekly adherence checks. These automated interactions screen for cravings and medication side effects, escalating high-risk responses to a clinical care manager immediately.

Best Practices
  • Schedule calls during high-risk times like Friday afternoons.
  • Use AI to detect sentiment changes in the patient's voice.
Common Pitfalls
  • Over-relying on patient portals which SUD patients often underuse.
5

Map BHI Add-on Code Requirements

Map out the specific requirements for the 2026 BHI add-on codes (G0568-G0570). Ensure that care management activities specifically target the behavioral health aspects of the patient's substance use disorder.

Best Practices
  • Document specific psychiatric collaborative care model (CoCM) elements.
  • Ensure the billing team is updated on 2026 APCM changes.
Common Pitfalls
  • Missing the additional revenue by only billing the base APCM code.
6

Automated Documentation and Logging

Ensure all non-face-to-face time is meticulously logged. AI phone systems should automatically push call duration and summary notes into the EHR to prove the 20-minute threshold for APCM billing is met.

Best Practices
  • Use AI transcription to capture qualitative recovery progress.
  • Review logs weekly to ensure no patient falls below the 20-minute mark.
Common Pitfalls
  • Manual time tracking which leads to under-reporting and lost revenue.

Expected Outcomes

1

Increased MAT retention rates

2

Full 42 CFR Part 2 compliance

3

Maximized revenue via BHI add-on codes

4

Reduced relapse incidents through proactive monitoring

5

Improved patient satisfaction scores

Frequently Asked Questions

Codes G0568-G0570 provide additional reimbursement for the intensive management required for SUD patients, acknowledging that addiction care often exceeds standard APCM complexity.

No, provided the AI platform is HIPAA-compliant and the patient has signed a specific Part 2 consent form allowing the technology partner to process health information for care coordination.

The AI system triggers an immediate alert to the clinical team, allowing for rapid intervention to prevent relapse or treatment dropout, which is a core component of the APCM quality framework.

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SUD APCM Patient Enrollment Workflow Guide | Tile Health