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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.

6/2/25 Nasal naloxone dispensing and billing changes for July 1
5/13/25 Do not bill greater than $99,999 on Med Adv professional claims
4/22/25 Educational program for coding E/M services starts in May
4/15/25 Billing guidelines for dually eligible members
4/2/25 Updated payment policies now available
4/2/25 Reminder for NOC code supporting documentation
4/1/25 Second quarter 2025 hospital outpatient fee schedule posted
3/25/25 Billing reminders for community mental health centers
1/21/25 Claims reminder: Submit member’s name exactly as shown on ID card
1/10/25 Updated payment policies now available
12/27/24 American Medical Association new telehealth codes
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