Billing & payment news
Provider-based billing policy went into effect June 1
Our provider-based billing policy went into effect June 1.
June 29, 2025
Understanding why a claim denied
We've created a new resource to help you understand exactly why a claim may have denied and be able to take any appropriate next steps.
June 29, 2025
New or corrected claims requirement for retro authorizations
Starting Dec. 9, submit new or corrected claims when you get a retroactive authorization after a claim denial.
June 29, 2025
Informal claim reviews required before appeals
To support you through the claim dispute process to make sure your questions / concerns are addressed in a timely manner – and you’re paid accurately and fairly for the care you’ve provided to our members – we’re sharing a few reminders and tips for our claim review and appeal process.
June 29, 2025
Submitting requested medical records for claims processing
Follow this process when submitting requested medical records to ensure they're linked with the right claim.
June 29, 2025
Void claims now appear on remittance advice with original claims
Since June 2024, void claims now appear on your remittance advice with the original claim adjustment.
June 29, 2025
Simplifying EFT setup
Soon, we’ll simplify our electronic funds transfer (EFT) setup process in prism, making it easier for us to work together on your EFT setup and management needs.
June 29, 2025
Resolving claims denying incorrectly for no anatomical modifier
We're reprocessing claims that recently denied for no anatomical modifier when they shouldn't have.
June 29, 2025
Changes for Medicaid claims for select home health care services
Changes coming for Medicaid claims submissions for select home health care services
June 29, 2025
ER imaging claims reprocessing
We're adjusting ER imaging claims that rejected incorrectly for no authorization.
June 29, 2025
Upfront claim rejections for member mismatch
Review the criteria our system looks at to match a claim to one of our members. If any of these don’t match exactly what we have in our system, the claim will be rejected.
June 29, 2025
New coding policies posted to the Provider Manual
We recently posted the following policies to our Provider Manual.
June 29, 2025