The Provider Manual updates include changes in the following chapters:

Documentation:

• 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.