| |
 | | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
 | Policy Bulletin User Information
 | |
| | |
| | |
| | |
| | |
| | |
| Claim Payment Policy Bulletins | |
|
| |
| | |
| | |
| | |
| | |
| A claim payment policy bulletin is the Company’s administrative communication to providers, members, and Company associates that describes the Company's coverage and reimbursement position on a specific topic; the requirements for coverage and reimbursement; the instructions for reporting specific services, a class of services, and/or codes (eg, diagnosis, procedure, procedure code modifier); and/or a description of the claims systems logic applied to procedure code combinations.
A claim payment policy is developed or revised as a result of any of the following:
- Basic product benefits, limitations, or exclusion information
- Changes to provider, ancillary, or facility contracts
- Updates to coding (eg, Current Procedural Terminology [CPT], Healthcare Common Procedure Coding System [HCPCS]) and/or claims systems conventions
- Company business decisions affecting coverage and/or administrative processes
- Legislatively mandated coverage requirements
- Scheduled review of existing policies
Although claim payment policies may include statements of coverage and/or reimbursement eligibility when policy requirements are met, individual member benefits must be verified, as they may vary by region, product, and/or contract.
Claim payment policies may be developed without the need for scientific evidence to support their position and use, as these are used primarily to define the processes and procedures for doing business with the Company. These policies are reviewed and approved by the appropriate Company committee(s) prior to publication. | |
|
| |
|