Provider Policies

A list of our clinical policies can be found here

Our medical clinical policies can be found here

Regarding any policy listed below in “Draft” status, please offer your feedback by clicking here. Please list Policy Feedback-Draft Status-Policy Name as it appears below in the subject line of your email.

Administrative Policies

Reimbursement Billing Policies

Policy Name  -  Posted Date  -  Effective Date  -  Status

Age Consistency Maternity Diagnosis   - 03/26/2018  -  04/20/2018  -  Active

Air Ambulance Covered Destinations   - 03/26/2018  -  06/19/2018  -  Active

Ambulance ALS and BLS Approved Diagnosis   -  10/22/2018  -  06/19/2018  -  Active

Ambulance Bill Code Types   -  05/24/2018  -  06/19/2018  -  Active

Ambulance Modifier QL -  -05/24/2018  -  06/19/2018  -  Active

Ambulance Non-Covered Origins and Destinations   -  05/24/2018  -  06/19/2018  -  Active

Ambulance Non-Covered Transportation and Trans Related Services   -  05/24/2018  -  06/19/2018  -  Active

Ambulance Place of Service Codes   -  05/24/2018  -  06/19/2018  -  Active

Ambulance Policy-Mileage   -  05/24/2018  -  06/19/2018  -  Active

Ambulance Services and required Modifiers   -  10/22/2018  -  06/19/2018  -  Active

Ambulance Services Ground   -  05/24/2018  -  06/19/2018  -  Active

Ambulance Services Ground Emergency   -  05/24/2018  -  06/19/2018  -  Active

Ambulance Supplies Service and Transport   -  05/24/2018  -  06/19/2018  -  Active

Ambulatory Surgery Excessive Units   -  05/24/2018  -  06/19/2018  -  Active

Anesthesia Limit Reimbursement and Frequency  -  08/27/2018  -  06-25-2018  -  Active          

Anesthesia Maternity Related   -  05/24/2018  -  06/24/2018  -  Active

 

Policy Name  -  Posted Date  -  Effective Date  -  Status

Bundled Facility-Outpatient Treated as Inpatient -  03-26-2018  -  07-01-2018  -  Active

Bundled Facility Payment -  03/26/2018  -  07/01/2018  -  Active

Bundled Facility Pre-Admission  -  03/26/2018  -  07/01/2018 -  Active

Cardiology EM Services with Implantable Device  -  03/26/2018  -  07/01/2018 -  Active

Cardiology-Duplex Scan for Carotid Artery Stenosis  -  03/26/2018  -  05/02/2018 -  Active

Diagnosis Code Guidelines-ICD 10 Laterality -  03/26/2018  -  05/02/2018  -  Active

Duplicate Services Policy-Duplicate Services from same NPI   -  03/26/2018  -  05/02/2018  -  Active

E & M Services with Implantable Cardiac Device  -  03/19/2018  -  08/01/2018  -  Active

Experiemental and Investigational Services  -  05/24/2018  -  06/26/2018  -  Active

Policy Name  -  Posted Date  -  Effective Date  -  Status

Hair analysis and metal testing  -  05/24/2018  -  07/01/2018  -  Active

Incorrect bilateral increase    -  05/24/2018  -  07/01/2018  -  Active

Invalid Bill Code Types    05/24/2018  -  07/23/2018  -  Active

Manually Priced Codes to pay 20%    - 03/01/2018  -  03/01/2018  -  Active

Modifier-Anatomical Modifiers   -  04/20/2018  -  05/02/2018  -  Active

Multiple Surgery Reduction Physician  -  05/24/2018  -  08/14/2018  -  Active

 

Policy Name  -  Posted Date  -  Effective Date  -  Status

Neurology Policy-Ambulatory 24 hour03/26/2018  -  05/02/2018  -  Active

Neurology-Polysomnography 03/26/2018  -  05/02/2018  -  Active

Observation Direct Admission without Paid Observation Services -  07/01/2018  -  07/01/2018  -  Active

Observation-Frequency of Observation -  07/01/2018  -  07/01/2018  -  Active

Place of Service inpatient only and non-inpatient surgical  -  03-26-2018  -  05-02-2018  -  Active

Place of Service-Inpatient Only Services  -  03/26/2018  -  05/02/2018  -  Active

Place of Service Outpatient vs. Inpatient  -  08/27/2018  -  08/01/2018  - Active

Place of Service-Special Services, Procedures and Reports -  10/05/2018  -  05/02/2018  -  Active

Revenue Code HCPCS Code Links03/26/2018  -  05/02/2018  -  Active

Urine Drug Testing  -  05/24/2018  -  06/24/2018  -  Active