We want to assist physicians, facilities and other providers in accurate claims submissions and to outline the basis for reimbursement if the service is covered by a member’s benefit plan. Keep in mind that determination of coverage under a member's benefit plan does not necessarily ensure reimbursement. Please note:
- These policies may be superseded by state, federal or Centers for Medicare and Medicaid Services (CMS) requirements.
- Providers and facilities are required to use industry standard codes for claim submissions.
- Services should be billed with Current Procedure Terminology (CPT) codes, Healthcare Common Procedure Coding System (HCPCS) codes and/or revenue codes.
- The billed code(s) should be fully supported in the medical record and/or office notes.
- Industry practices are constantly changing, and we reserve the right to review and revise policies periodically.
Reimbursement policy disclaimer
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- Prior Authorization Lookup Tool
- Prior Authorization Requirements
- Claims Overview
- Reimbursement Policies
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