Claims and Payment Policies

Claims Policies
picture_as_pdfBrineura
picture_as_pdfInterleukin 5 Inhibitors
picture_as_pdfLupron
picture_as_pdfVelcade

Payment and Reimbursement Policies
picture_as_pdfAcute Care and Psychiatric Inpatient Readmissions
picture_as_pdfAmbulance Policy
picture_as_pdfAmbulatory Surgical Centers/Free Standing Surgical Centers
picture_as_pdfAssistant Surgeon
picture_as_pdfBehavioral Health for Members Age 18 and Younger
picture_as_pdfChiropractic Reimbursement Policy
picture_as_pdfClinical Trial Reimbursement Policy
picture_as_pdfEarly, Periodic, Screening and Diagnostic Treatment (EPSDT)
picture_as_pdfFacility-Based Behavioral Health Services
picture_as_pdfFederally Qualified Health Centers Claims (FQHC) Processing Guidelines
picture_as_pdfHome-Delivered Meals for LTSS Members
picture_as_pdfHospice
picture_as_pdfICD-10-CM Official Guidelines and Reporting Excludes Notes Policy
picture_as_pdfIncarcerated Members Reimbursement Policy
picture_as_pdfOutpatient Dialysis and Home Dialysis
picture_as_pdfPharmacy Medical Benefit Guidelines
picture_as_pdfPhysician Assistants (PAs) and Advanced Practice Registered Nurses (APRNs) Reimbursement Policy
picture_as_pdfPractitioner and Facility Emergency Department Policy
picture_as_pdfRadiopharmaceutical/Radiology
picture_as_pdfRespite Care-Pediatric Non-LTSS
picture_as_pdfSchool-based Wellness Centers (SBWCs)
picture_as_pdfSelf-Directed Attendant Care (Non-LTSS Pediatric)
picture_as_pdfTelehealth Policy
picture_as_pdfTelehealth Policy Appendix
picture_as_pdfTherapy Services
picture_as_pdfVaccinations
picture_as_pdfWellness Visits for Adults, Women, and Children