What are Payment Policies
Blue KC has developed Provider Payment Policies to provide guidance on payment methodologies as they pertain to submitted claims. These policies are written following industry standard recommendations from sources such as:
- Current Procedural Terminology
- Centers for Medicare and Medicaid
- American Medical Association
- National Correct Coding Initiative
- Other professional organizations and societies
Coverage of any service is determined by date of service, a member's eligibility and benefit limits for the service or services rendered, all terms of the Provider Service Agreement, and other standards of coding rules and guidelines. Final payment is subject to the application of claims adjudication and edits common to the industry. For confirmation of which services may be eligible for coverage and description of when medical services are considered medically necessary, not medically necessary or investigational. In the event of a conflict between any policies, the Member's coverage document will govern.
New Payment Policies (published within last 30 days)
Blue KC has recently made changes to the following payment policies.
|2023 CPT Evaluation and Management Guidelines|
|IOP, PHP, and Inpatient Treatment Services for Substance Abuse and Psychiatric Care|
|Organ Acquisition Costs|
Updated Payment Policies (updated within last 30 days)
|Critical Care Services|
|Revenue Codes Requiring CPT or HCPCS Codes|
All Provider Payment and Coding Policies
List of all Payment and Coding Policies (A-Z).