Provider Manual Updates

The Provider Manual December 2020 updates include changes in the following chapters:

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)

To view the updated Provider Manual, please visit

For reimbursement policies, please visit our website at

Reimbursement notices are found in our fee schedule portal at