The Health Plan utilizes established guidelines provided by governing bodies of the federal and state levels of government to process medical claims. With daily industry updates, changes in medical billing, continued education of staff, and utilization of the Internet, we can provide resources to assist you with required documentation for medical services appropriate to coding and use of modifiers.
Suggested Internet resources include:
Center for Medicare and Medicaid Services (CMS)
Resources available include EM guidelines, NCCI guidelines, fee schedules and review information. You can register on email lists to obtain updates as published.
Office of Inspector General (OIG)
Resources available include billing guidelines and review results. You can also register on email lists to obtain updates as published.
Access specialty websites like The American Congress of Obstetricians and Gynecologists (ACOG)
Another resource to consider is the local office managers and coding groups in your area. The sharing of ideas and concerns will assist with obtaining answers or resolutions to your concern.
The Health Plan can assist in general inquiries or review of specific claims impacted by the correct coding issues. Please do not hesitate to contact Provider Relations at 1.800.624.6964 or 740.695.7649 or email us firstname.lastname@example.org.