Review information on coding and billing certain types of claims and how our bundling software affects claim processing.
- Allergy Services
- Billing for Non-Covered Services
- ClaimsXten Rule Descriptions
- Clear Claim Connection (C3)
- Clinical Payment and Coding Policies
- Coordination of Benefits and Patient Share
- Cotiviti, Inc Edit Descriptions
- Documentation and Coding
- Asthma and Asthma Associated Condition
- Atrial Fibrillation Documentation & Coding
- Cancer and Cancer Related Treatments Coding
- Chronic Kidney Disease Coding
- Diabetes Mellitus Documentation & Coding
- Human Papillomavirus Documentation & Coding
- Hypertension
- Major Depressive Disorder Documentation & Coding
- Medicare Annual Health Assessments – Quick Reference Guide on Initial Preventive Physical Exams and Annual Wellness Visits
- Medication Reconciliation Post-Discharge
- Mental, Behavioral, Neurodevelopmental Disorders
- Obesity and Morbid Obesity Documentation and Coding
- Vascular Disease Documentaton and Coding
- Locum Tenens
- Modifiers — Refer to the Clinical Payment and Coding Policy page for the Modifier Reference Guidelines as well as specific service policies. In addition, participating providers can refer to modifier information in the secure content area of the General Reimbursement Information page.
When submitting electronic claims, if the modifier requires submission of medical records, fax the medical records to one of the following numbers listed below within 72 hours of submitting your claims (include a note indicating the member’s group number and member ID number including the 3-character prefix and state ”Medical records for claim (indicate DCN #) submitted on mm/dd/yyyy for ‘Patient Name’ ”):
- Outpatient Surgery Codes with Increased Reimbursement When Performed at an Ambulatory Surgery Center
- Pass-Through Billing
- Preventive and Follow Up Colonoscopies
- Proper Billing for Supplies for Transcutaneous Electrical Nerve Stimulation Units
- Proper Speech Therapy Billing
- Services Rendered by Providers to Related Members and/or Self
- Surgical Procedures Performed in the Physician's and Other Professional Provider's Office