Policies
This policy lists bundled services that are not reimbursable services regardless of whether they are billed alone or in conjunction with other services
What are B bundle codes policy
This Medicare plan type has no OON benefits
What is HMO
Used to determine the time frame in which a provider has to submit a claim
What is timely filing tool
This is used to determine how to complete an authorization correctly.
What is authorization entry grid
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What is Earth
This policy uses column one/column two logic. When reported with a column one code, a column two code is not reimbursed unless it is billed with an approved modifier
What is CCI edits policy
For this state we only cover the DSNP plans
What is DC
Used to provide contact numbers and claims addresses for specific states.
What is provider resource tool
Used to determine if a case can be backdated and how far it can be backdated if possible.
What is late notifications & retrospective request job aide
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What is Thor
This policy is used for determining if add-on codes are reimbursable services when reported in addition to the appropriate primary service by the Same Facility reporting the same Federal Tax Identification Number unless otherwise specified within the policy
What is add-on codes policy
Plans that require prior authorization for OON.
What is Medicaid & Medicare HMO
This is used to pull EOB's, claim images and other provider/member correspondence.
What is DOC 360
Used to document notes on all cases.
What are the documentation templates
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What is Nope
This policy identifies and combines specific coding relationships into the most comprehensive and/or appropriate procedure code.
What is rebundling policy
NC/VA/DC
What are the states we cover
This tool is used to view claims more simplified.
What is PDAT
It is the system used to submit authorization requests.
What is ICUE
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This policy provides global reimbursement guidelines for maternity care, which includes ante partum, delivery services, and postpartum care
What is OB services policy
These state plans have no OON benefits
What are Medicaid plans
Used to get specific authorization requirements for each state
What is the SSG
They are used when checking a code for authorization requirements.
What is the EPAL & PNL
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