Coding, Billing and Bundling Information
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
- Clinical Payment and Coding Policies
- Coordination of Benefits and Patient Share
- Cotiviti, Inc Edit Descriptions
- Documentation and Coding Tips
- 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’ ”):
- (972)468-3980
- (972)468-3982
- (972)468-3983
- (972)468-3984
- Obstetrical Billing & Multiple Birth Guidelines
- Pass-Through Billing
- Preventive and Follow Up Colonoscopies
- 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
- Urgent Care Center Services Billed Using CPT Code S9088
- Urine Drug Testing Documentation Guidelines
