Provider Manual Updates

We’ve made updates to the Provider Manual for December 2020, and the changes are listed below for your reference.
Claim Submission

  • Timeframe for Claim Submission


  • Evaluation and Management (E/M)Documentation Requirements

Documentation Removed –(Information is now available through the Availity Provider Portal)

  • 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

Reimbursement & Billing Guidelines
The following chapters have been updated or relocated due to new reimbursement policies or notices.

  • All Patient Refined – Diagnosis Related Groups (APR-DRG)
  • Acute Inpatient (APR-DRGS) Hospital Billing  
  • Behavioral Health Inpatient Acute (APR DRGS) – Institutional Billing 

New chapter additions

  • Enhanced Ambulatory Patient Group(EAPG)

See the updates and other provider information

View reimbursement notices in the fee schedule portal