Billing & payment news
2025 commercial fee schedules are available online
2025 commercial fee schedules are available online
June 29, 2025
Understanding disallow code OX6
It’s important to us that you understand the way your claims are handled – including what the various codes that may appear on your remittance advice mean. One claim adjustment code we get a lot of questions about is OX6.
June 29, 2025
New and updated billing policies are now available
We’ve posted several new and updated billing policies, which align to industry standards, to the Provider Manual.
June 29, 2025
Resolving some vaccine codes denying incorrectly
We're correcting two issues with vaccine claims denying when they shouldn't.
June 29, 2025
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