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_pdfAmbulatory Surgical Centers Medical Claims Processing Guidelines
picture_as_pdfBehavioral Health Reimbursement Policy for Members Under Age 18
picture_as_pdfEarly, Periodic, Screening and Diagnostic Treatment (EPSDT)
picture_as_pdfFacility-Based Behavioral Health Services Reimbursement Policy
picture_as_pdfFederally Qualified Health Centers Claims (FQHC) Processing Guidelines
picture_as_pdfHome-Delivered Meals for LTSS Members Reimbursement Policy
picture_as_pdfICD-10-CM Official Guidelines and Reporting Excludes Notes Policy
picture_as_pdfObservation and Extended Assessment and Management in Facilities
picture_as_pdfPhysician Assistants and Advanced Practice Registered Nurses
picture_as_pdfPractitioner and Facility Emergency Department Policy
picture_as_pdfTelehealth Policy
picture_as_pdfTelehealth Policy Appendix
picture_as_pdfWellness Visits for Adults, Women, and Children