New billing policies posted to the Provider Manual
The following billing and coding policies were recently posted to or updated in the Provider Manual’s billing policies webpage in June 2024.
Aligning commercial DME billing and coding with CMS
Starting Aug. 1, 2024, we’re aligning our commercial billing and coding requirements for durable medical equipment (DME) supplies to those defined by the Centers for Medicare and Medicaid Services (CMS).
New and updated billing policies now available
In alignment with industry standards, we’ve posted several new and updated billing policies to the Provider Manual.
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.
Reprocessing 2024 & 2025 anesthesia claims
Since Jan. 1, 2024, anesthesia claims have been incorrectly overpaid. We’ll follow our corrections to payments policy to recoup the overpayments.
Seeing in prism why a claim denied is easier than ever
We recently improved the Claims section in prism, pulling all claim denial details and rationale into one place. No additional buttons to click or external resources to access.
June 2025 billing policy updates
We recently published or updated several billing policies, now available in our Provider Manual.
Reprocessing physical therapy claims
We’re reprocessing physical therapy claims from the past few weeks due to a payment error.
Reprocessing CRNA claims
We're reprocessing 2025 CRNA claims due to a payment error.
RAs for May CM checks are being delivered late
Remittance advices (RAs) for our May 2025 care management (CM) payment checks are being delivered late. Checks have already been delivered.
CS modifier no longer valid
Effective July 28, 2025, claims submitted with the CS modifier will be denied. You’ll see denial code “E1J – Modifier used inappropriately” in prism.
DPP program billing reminder
Follow MDHHS billing guidelines for our Diabetes Prevention Program for Medicaid members.