Member Provider and Procedure Manual 2027

Reference Section - Updated 1/1/2027
Section 1: Network Overview - Updated 1/1/2027
Section 2: Network Participation - Updated 1/1/2027
Section 3: Member Engagement 
Section 4: Medical Management - Updated 1/1/2027
Section 5: Billing and Reimbursement Guidelines
Section 5.1: General Billing and Reimbursement - Updated 1/1/2027
Section 5.2: After Hours Care
Section 5.3: Ambulance Transport Benefit
Section 5.4: Anesthesia - Updated 1/1/2027
Section 5.5: Autism
Section 5.6: Behavioral Health - Updated 1/1/2027
Section 5.7: Code Editing - Updated 1/1/2027
Section 5.8: Dialysis - Updated 1/1/2027
Section 5.9: Dietitian
Section 5.10: Drug Eluting Intracoronary Stents
Section 5.11: Drug Screening Assays
Section 5.12: Home Health Agency - Updated 1/1/2027
Section 5.13: Inpatient - Updated 1/1/2027
Section 5.14: Inpatient Unbundling Policy
Section 5.15: Intra-operative Monitoring Services
Section 5.16: Laboratory - Updated 1/1/2027
Section 5.17: Maternity Care and Delivery - Updated 1/1/2027
Section 5.18: Multiple Service Reduction for Diagnostic Imaging Services
Section 5.19: Nucleic Acid Probe Services
Section 5.20: Outpatient
Section 5.21: Pass Through Billing and Billing for Services Not Rendered
Section 5.22: Place of Service - Updated 1/1/2027
Section 5.23: Provider Based Billing
Section 5.24: Sleep Study
Section 5.25: Urgent Care Centers
Section 5.26: Fertility Preservation Services
Section 5.27: Medical Records Documentation
Section 5.28 Ambulatory Surgery Centers
Section 5.29 Clinical Trials
Section 5.30 Multiple Procedure Reductions For Facility Therapy Services
Section 6: Other Coverage - Updated 1/1/2027
Section 7: Claims Submission - Updated 1/1/2027
Section 8: Claims Resolutions - Updated 1/1/2027
Section 9: MS-DRG Type of Service Listing
Appendix I: Online Resources - Updated 1/1/2027
Appendix II: Forms - Updated 1/1/2027
Appendix III: Definitions - Updated 1/1/2027
Appendix IV: Taxonomy Codes - New 1/1/2027

Printable PDF of Entire Manual - Updated 1/1/2027