Please verify benefit coverage prior to rendering services. Inpatient services and non-participating providers always require prior authorization.
Elective services provided by or arranged at nonparticipating facilities.
All services billed with the following revenue codes:
|0023||Home health prospective payment system|
|0240–0249||All-inclusive ancillary psychiatric|
|0570–0572, 0579||Home health aide|
|0632||Pharmacy multiple sources|
|0901, 0905-0907, 0913, 0917||Behavioral health treatment services|
|0944-0945||Other therapeutic services|
|0961||Psychiatric professional fees|
|3101-3109||Adult day and foster care|
Check the latest Formulary for the members’ service area on our Benefits and Pharmacy page.