General Reimbursement Information

Manuals

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Medical Policy Request Form

Medical Policy Request Form


Clinical Payment and Coding Policies

View Clinical Payment and Coding Policies


Preauthorization/Notification/Referral Requirements Lists

View Lists


Recoupments/Refunds

Recoupment Process

Refund Policy


Reimbursement Schedules and Related Information

Professional

Compound Drugs

Hospital/Ambul. Surg Ctr./Endoscopy Ctr.

Rehabilitation Facility/LTAC/SNF/Acquired Brain Injury

Ancillary

Ancillary/Hospital Fee Schedule Request


Bundling Information


All Product News

Allergy Services

Anesthesia

Assistant at Surgery Logic


Modifier Reimbursement

Modifiers — Prof. Claims


Molecular Pathology Procedure Test Codes 


Multiple Imaging Procedures Reduction

Multiple Surgery — Prof

Pass-Through Billing


Procedure Plus an Evaluation and Management Service


Texas HMO Outpatient Clinical Reference Lab Services Effective 9/1/2017


For HMO physicians and other professional providers located in counties on the HMO Reimbursable Lab County Listing, lab services on the Reimbursable Lab Services List will be reimbursed on a fee-for-service basis if performed in the physician's or professional provider’s office. All other lab services for HMO members must be referred to the exclusive HMO lab provider - Quest Diagnostics, Inc.

Blue EssentialsSM Outpatient Clinical Reference Lab Service through 08/31/17

(Performed in the Physician or other Professional Provider office)


Member Liability Estimate

Member Liability Estimate