We publish billing policies to offer transparency and help providers bill claims more accurately to reduce delays in processing claims, as well as avoid rebilling and additional requests for information.
The following billing policies were recently published to or updated in our Provider Manual.
Note: If the effective date is listed as “N/A”, the policy represents our current system set up and expectations for transparency. There are no changes for providers as the policy is already in effect.
| Policy | New or updated | Description | Effective date |
| Claim submission guidelines | Updated | This policy primarily compiles guidelines already present in our online Provider Manual and that are already in effect. With the publishing of this policy, we added guidelines for taxonomy codes that will go into effect on May 19, 2025. | May 19, 2025 (taxonomy codes only) |
| Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring) | New | This policy defines billing, reimbursement and documentation guidelines for Cardiac Event Detection (CED) and Holter Monitoring (24-hour ECG monitoring). | N/A |
| Flow cytometry | New | This policy defines our current reimbursable limitations and documentation requirements associated with flow cytometry. | N/A |
| Magnetoencephephalography (MEG) | New | This policy identifies the billing and documentation requirements associated with Magnetoencephalography (MEG). | N/A |
| Miscellaneous DME | Updated | Added information on seat lift mechanisms | N/A |
| Oxygen and oxygen supplies | New | This policy identifies the payment and documentation requirements associated with oxygen and oxygen supplies. | May 19, 2025 |
| Radiation oncology | Updated |
| May 19, 2025 |
| Semiprivate vs private room | New | This policy defines billing, reimbursement and documentation guidelines for semiprivate rooms and private rooms for patients in a hospital setting. | N/A |