Find Care in Your Area
search
  1. Claims and Medical Policies
  2. Claims and Payment Policies
  1. Home
  2. For Providers
  3. Claims and Medical Policies
  4. 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_pdfCognitive Services-LTSS
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_pdfInfusion Site of Care
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_pdfPrivate Duty Nursing
picture_as_pdfRadiopharmaceutical/Radiology
picture_as_pdfRespite Care - LTSS
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_pdfTherapy Services
picture_as_pdfVaccinations
picture_as_pdfWellness Visits for Adults, Women, and Children