Policy Bulletin Library
Our policy bulletins communicate our medical and claim payment reimbursement positions for services administered in relation to the applicable member’s benefits.
We have created two sections of the library below, one for medical policies and one for claim payment polices.
All policy documents are considered complimentary to our Provider Manual.
Medical Policy Bulletins
Our Medical Policy bulletins define medical necessity criteria and coverage positions on topics such as medical services, procedures, DME, therapies, drugs, etc.
|
Policy Bulletin # |
Title |
Summary |
Original Implementation Date |
Version Date |
| AD.001.C | Medicare Readmissions | Documents our position on Medicare readmissions | 1/1/2014 | 4/1/2018 |
| DR.001.A | Soliris (Eculizumab) | Documents our position on Soliris (Eculizumab) | 3/26/2018 | 3/26/2018 |
| MN.005.A | E&I | Documents our coverage position for E&I Services, IDEs, and CEDs | 8/1/2016 | 8/1/2016 |
| MN.006.D | Cosmetic & Reconstructive Services | Documents our coverage position for cosmetic and reconstructive services | 10/1/2007 | 1/1/2018 |
| MN.008.A | Genetic Testing | Documents our coverage position on genetic testing | 10/16/2016 | 10/16/2016 |
| MN.010.A | Gender Confirmation | Documents our position on gender confirmation | 11/6/2016 | 11/6/2016 |
| MN.011.A | Whole Genome and Whole Exome Sequencing | Documents our position on WGS and WES | 11/1/2017 | 11/1/2017 |
| MN.012.A | LINX™ Reflux Management System | Documents our position on the LINX™ Reflux Management System | 11/1/2017 | 11/1/2017 |
| MN.013.A | Shift Nursing, Personal Care, and Medical Daycare | Documents our position on Shift Nursing, Personal Care, and Medical Daycare | 1/30/2017 | 1/30/2017 |
Medical Policy Type Key: AD = Administrative; DR = Drug; MN = Medical Necessity
Claim Payment Policy Bulletins
Our Claim Payment policy bulletins provide reimbursement rules and billing guidelines necessary to ensure timely and appropriate payment.
|
Policy Bulletin # |
Title |
Summary |
Original Implementation Date |
Version Date |
| RB.001.A | Ambulance Ground Mileage Claim | Documents our reimbursement rules for ambulance ground mileage and ambulance services | 10/1/2015 | 10/1/2015 |
| RB.004.A | Modifier 50, Bilateral Procedure | Documents our position on modifier 50, bilateral procedure | 3/31/2016 | 3/31/2016 |
| RB.005.A | Modifier 25 | Documents our position on Modifier 25 | 7/1/2016 | 7/1/2016 |
| RB.006.A | STAT Labs | Provides reporting requirements and reimbursement rules for STAT laboratory tests (aka, labs) | 7/1/2016 | 7/1/2016 |
| RB.007.B | DME Continuous Rental | Documents our position on durable medical equipment (DME) rentals | 11/1/2015 | 5/25/2018 |
| RB.014.A | Observation Care
FAQ |
Documents our position on Observation Care services
Provides answers to common questions |
3/15/2018 | 3/15/2018 |
Claim Payment Policy Type Key: BN = Benefit; RB = Reimbursement
Please note:
- The effective date of select policy bulletins found in the Policy Bulletin Library above may considerably pre-date the actual date of their availability on this Policy Bulletin Library web page. This is because the Policy Bulletin Library will include PDFs of policies that have been in effect for many years, but have not been previously published on our website.
- New and updated policy bulletins will typically be published in the Policy Bulletin Library 30 to 60 days prior to their implementation date, ensuring that your office is given appropriate notification of changes and updates that may affect your office.