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(904) 363-5870
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Overview
──────────
News
Bulletins and FAQs
Bluemail (email)
──────────
Availity Online Services
──────────
Behavioral Health
Behavioral Health Ecosystem
Measurement-Based Care in Behavioral Health
Psychotherapeutic Medication Guidelines
Virtual Treatment
Advocacy Resources
──────────
Billing
Companion Documents
Forms
──────────
Medical & Pharmacy Policies
Dental Information
Medical Policies (Medical Coverage Guidelines)
Medication Guide
Medical Policy, Pre-Certification, Pre-Authorization
Part B Step Therapy
Payment Policies
Pharmacy Utilization Management
Practice & Preventive Service Guidelines
Prior Authorization
Specialty Pharmacy
──────────
Online Training
──────────
Programs
Advance Care Planning
CMS Member Survey Experience
Federal Employee Program
Kidney Health Management
Quality: HEDIS & PQA Measures
Quality: Medicare Stars
Quality: Readmissions Review
Risk Adjustment
Utilization Management
Value-Based Alternative Payment
──────────
──────────
Pain Management
Chronic Pain Management
Opioid Addiction & Overdose Medication
──────────
Provider Manual
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File Name
Format
Updated
3D Rendering of Tomographic Modalities
PDF
October 2022
Add On Codes
PDF
July 2023
Administration of Injections and Infusions in Facility Settings
PDF
September 2023
After Hours and Weekend Care
PDF
March 2023
Ambulance Services
PDF
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Anesthesia Services
PDF
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Bilateral Procedures - Professional & Institutional Billing
PDF
October 2022
B-Status Codes
PDF
July 2023
Care Coordination Services
PDF
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Consultation Services
PDF
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Co-Surgeons (Two Surgeons)
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Discontinued Procedure-53 Modifier
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Evaluation & Management for Office or Other Outpatient Services
PDF
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Evaluation & Management Services by Physicians in the Same Group Practice
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Facility Reimbursement for Clinic Services
PDF
December 2022
Global Surgery Package
PDF
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Hospital Related Services for or Leading to an Inpatient Admission
PDF
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Hospital Related Services for Outpatient Claims
PDF
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Increased Procedural Services (Modifier-22)
PDF
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Initial Hospital Care Evaluation & Management Services
ARCHIVE
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Initial Hospital Inpatient or Observation Evaluation & Management Services
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Institutional Payment Programs and Charge Based Reimbursement for Commercial Products
PDF
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Institutional Reimbursement as Inpatient versus Outpatient NEW
PDF
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Institutional Supplies Policy
PDF
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Laboratory Panels and Components
PDF
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Maximum Units of Service
PDF
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Modifier Reference
PDF
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Multiple Diagnostic Cardiovascular Procedure Reduction
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Multiple Diagnostic Ophthalmology Procedure Reduction
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Multiple Imaging Reduction
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Multiple Procedure Reduction - Home Infusion Therapy Per-Diem
PDF
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Multiple Surgical Procedure Reduction (Including Multiple Endoscopic Procedure Reduction)
PDF
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Multiple Therapy Reduction
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Multiple Visit Reduction
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National Correct Coding Initiative
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Never Event – Hospital Acquired Condition (HAC) in Inpatient Setting
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Never Events - Wrong Surgery
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New Patient Visits
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NonPhysician Healthcare Professionals Billing E-M Codes
PDF
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Hospital Inpatient or Observation Discharge Policy
PDF
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Outpatient Facility Alternate Procedure Code Reimbursement NEW
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Observation and Discharge Policy
ARCHIVE
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Portable X-Ray and EKG Supplier Services
PDF
July 2023
Professional Technical Component
PDF
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PDF
June 2023
Prolonged Services
ARCHIVE
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April 2022
Readmissions Review Quality Program for MA & Comm
PDF
January 2023
Reduced Services-52 Modifier
PDF
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Reporting Habilitative and Rehabilitative Services
PDF
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Robotic Assisted Surgery
PDF
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Robotic Assisted Surgery Facility Policy
PDF
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Split Surgical Package
PDF
October 2022
Standby Services
PDF
March 2023
Supplies
PDF
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Surgical Assistant
PDF
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Telehealth Facility Procedure Q3014
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Third Party Billing When a Member is Inpatient
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T-Status Codes
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Unbundled, Incidental, and Mutually Exclusive Services
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