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.