Ancillary
- Types of service covered
- Claims and billing
- Home based services - home health and hospice, medical equipment, infusion
- Prosthetics/Orthotics
- Alternative Care Services
Ancillary (04-2025)
Claims submission and payments
- Submitting claims
- CMS 1500 completion
- Reimbursement
- Explanation of Payment
- Statement of Overpayment Recoveries
- Appeals
Claims submission and payments (04-2025)
Coding and billing resources
- Coding guideline sources
- Provider type billing situations
- Procedure coding
- Submitting corrected claims
Coding and billing resources (04-2025)
Credentialing and contracting
- Credentialing process
- Contracting process
- Terminating a contract
- Credentialing and claims
- Confidentiality
- Information/address changes
Credentialing and contracting (04-2025)
Integrated health management
- Personal Health Support Services
- Types of review
- Pharmacy
- Quality program
Integrated health management (04-2025)
Member eligibility and coverage
- Eligibility and benefits
- Medical emergency
- Member appeals, rights, and responsibilities
- Member copays, co-insurance, and deductible
Member eligibility and coverage (04-2025)
UB-04 Billing
- Hospital inpatient notifications
- Transfer of patients
- Hospital bill audits
- Interim bills and late charges
- Ambulatory surgery centers (ASCs)
UB-04 billing (04-2025)
This Provider Manual is provided for informational purposes only and does not amend any applicable provider agreements. To the extent of any inconsistency, the applicable provider agreement and governing law will prevail. The Provider Manual doesn’t guarantee eligibility, coverage, authorization, reimbursement, or payment. Providers are responsible for verifying eligibility/benefits, obtaining required authorizations, and submitting accurate claims in compliance with applicable billing, coding, documentation, and regulatory requirements.