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 Billing & Reimbursement

The Billing & Reimbursement section is designated for information pertaining to claims, billing, and reimbursement information and changes. You and your office staff can stay up-to-date on topics including clean claims, proper coding for disbursements, remittances, and specific billing procedures.

The following user guides provide detailed information about Provider Explanation of Benefits (EOB)/Remittances:

Provider EOB/Remittance

  Communications


Hide details for [<div class= 'YearCat'>&nbsp&nbsp2019 Updates</div><hr style='width:749px; color:#b6b6b6;background-color: #b6
  2019 Updates

Claim investigation and corrected claim submission proceduresPosted: 09/17/2019
Now in effect: Enhanced claim edits to align with industry standard billing rules for injectable drugs and biological agentsPosted: 09/04/2019
Now in effect: New claim payment policies for multiple therapies Posted: 09/03/2019
Professional Injectable and Vaccine Fee Schedule updates effective October 1, 2019Posted: 08/26/2019
ICD-10 in Action: Chapter-specific guidelinesPosted: 08/15/2019
Enhanced claim edits to align with industry standard billing rules for injectable drugs and biological agents beginning September 1, 2019 Posted: 08/05/2019
Now in effect: Enhanced claim edits to align with industry standard billing rules for DME and P&O billing providers Posted: 08/05/2019
New claim payment policies for multiple therapies Posted: 08/01/2019
Billing and cost-sharing for individuals enrolled in the Qualified Medicare Beneficiary programPosted: 07/26/2019
National Drug Code submission guidelines for co-packaged products listed as kits and multi-level packaged productsPosted: 06/25/2019
Claim investigation and corrected claim submission proceduresPosted: 06/12/2019
Enhanced claim edits to align with industry standard billing rules for DME and P&O billing providers beginning August 1, 2019Posted: 06/12/2019
Enhanced claim edits to align with industry standard billing rules for injectable drugs and biological agents Posted: 06/03/2019
Professional Injectable and Vaccine Fee Schedule updates effective July 1, 2019Posted: 05/24/2019
Enhanced claim edits to align with industry standard billing rules for DME and P&O billing providersPosted: 04/15/2019
Claim reprocessing for multiple procedure payment reductions on certain diagnostic servicesPosted: 03/28/2019
Claim investigation and corrected claim submission proceduresPosted: 03/19/2019
Reminder: Guidelines for billing with taxonomy codesPosted: 03/07/2019
Professional Injectable and Vaccine Fee Schedule updates effective April 1, 2019Posted: 03/01/2019
Resolved: Overpayment impacting January 2019 capitation and PCP quality incentive payments for panels with Keystone 65 Focus Rx membership onlyPosted: 02/13/2019
Changes coming to application of Modifier 59 in 2019Posted: 01/11/2019
Overpayment impacting January 2019 capitation and PCP quality incentive payments for panels with Keystone 65 Focus Rx membership onlyPosted: 01/07/2019
Updated payer ID grids now available Posted: 01/07/2019
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  2018 Updates

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  2017 Updates

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  2016 Updates

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  2015 Updates

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  2014 Updates

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  2013 Updates

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  2012 Updates

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  2011 Updates












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