Reimbursement policies

We want to assist physicians, facilities and other providers in accurate claims submissions and to provide 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  • These policies may be superseded by state, federal or CMS requirements.  
  • Providers and facilities are required to use industry standard codes for claim submissions.  
  • Services should be billed with CPT® codes, 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.

Provider tools & resources

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We look forward to working with you to provide quality services to our members.