Our Member Services Representatives are unavailable Thursday, November 26, and Friday, November 27, due to the holiday. (Medium)

Provider Manual Updates

The Provider Manual updates include changes in the following chapters:


  • Documentation Guide for InterQual-Behavioral Health
  • Behavioral Interventions for the treatment of Autism
  • Child Psychiatric Residential Treatment Program
  • Psychiatric Partial Hospital Program
  • Substance Use Disorder Residential Treatment Program
  • Substance Use Disorder Partial Hospital Program
  • Adult Psychiatric Residential Treatment Program

New chapter additions:

  • Diabetes Prevention Program

The following chapters have been updated or relocated due to new reimbursement policies or notices:

  • Hospice Services
  • Home Medical Equipment
  • Dialysis
  • Home Infusion Therapy
  • Home Health Services
  • Inpatient – Skilled Nursing Facility Billing
  • Inpatient Swing Bed – Hospital Billing
  • Inpatient Transitional Care Unit – Hospital Billing
  • Endoscopy
  • Hospital Outpatient
  • Surgical Roll-up methodology
  • Trauma Activation
  • Acute Inpatient (APR-DRGS) Hospital Billing
  • Behavioral Health Inpatient Acute (APR DRGS) – Institutional Billing
  • Ambulance

As a reminder, reimbursement notices can be found in our fee schedule portal.