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Payment Integrity Policies

Switch to:

Payment Integrity Policies

The policies below apply to commercial and Medicare Advantage plans:

Annual Fee Schedule Update

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Claim Review Program

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Coding Validation

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CPT/HCPCS New Code Updates

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Device, Implant and Skin Substitutes Coding Guidelines (Facilities)

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Hospital Inpatient - Routine Supplies & Services

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Laboratory Benefit Management Program

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Pre/Post Pay Claim Reviews Policy

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Sepsis Coding - Pre/Post Claim Review

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Any information provided on this Website is for informational purposes only. It is not medical advice and should not be substituted for regular consultation with your health care provider. If you have any concerns about your health, please contact your health care provider's office.

Also, this information is not intended to imply that services or treatments described in the information are covered benefits under your plan. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage.