We publish billing policies to offer transparency and help you 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’s Billing Policies page.
Note: If the effective date is listed as N/A, the policy represents our current system set up and/or expectations for transparency. There are either no changes for you as the policy is already in effect or was recently shared with the network and we’re implementing a clinical edit in alignment with the policy’s language.
| Billing policy | Description | Effective date |
|---|---|---|
| New policies | ||
| Drug pricing | This policy outlines existing billing criteria around 340B drug pricing. | N/A |
| ED Level of care | This policy was added to align with compliance standards, coding guidelines and ensure proper reimbursement. Documentation should support the higher level of ED services billed. This review will be performed post-pay. | Apr. 19, 2026 |
| Facility to facility transfers | This policy was added to align with compliance standards, coding guidelines and ensure proper reimbursement. | Apr. 19, 2026 |
| Updated policies | ||
| Care management services | We clarified language and codes that can't be billed together. | Apr. 19, 2026 |
| Maternity and prenatal care | We added information about including all prenatal visit dates on the claim and additional denial language | N/A |
| Telemedicine | New codes added: 90849, 92622, 92623, 99426, 99427, G0473, and G0545 | N/A |