Reimbursement policies

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  • These policies may be superseded by state, federal or Centers for Medicare & Medicaid Services (CMS) requirements  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

Provider tools & resources

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