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Claims, Coding, Payment

In the “Current” tab, you’ll find news published during the past year. Use the “Archive” tab to view news going back an additional two years.

10/29/24 Standard claims filing timelines return in December
10/15/24 New coverage criteria for HIV PrEP for Medicare Advantage members
10/2/24 Updated payment policies now available
10/1/24 We will pay for inpatient stays until a member’s coverage ends
10/1/24 Fourth quarter 2024 hospital outpatient drug fee schedule posted
8/8/24 We have reconnected to Change Healthcare for some functionality
8/5/24 Routine foot care is generally not covered for Medicare Advantage
7/8/24 Billing reminder for drugs, biologicals, and drug wastage
7/8/24 Easing ER strain with access to out-of-network urgent care
7/1/24 Third quarter 2024 hospital outpatient drug fee schedule posted
7/1/24 Updated payment policies now available
6/5/24 Clarifying our NOC code supporting documentation requirements
5/1/24 Reminder: CPT and HCPCS modifiers
4/29/24 Services related to outpatient surgery not separately reimbursed
4/1/24 Updated payment policies now available
4/1/24 Second quarter 2024 hospital outpatient drug fee schedule posted
3/21/24 Do not bill dually eligible members
2/12/24 Billing reminder: RSV vaccine for pregnant women
1/4/24 Updated payment policies now available
12/13/23 Preparing for HEDIS 2024 medical record collection