Providers
Medical Providers
Provider Manual
Your source for commonly asked questions about healthcare coverage, claims procedures, policies and more.
View Provider ManualCoverage policy and pre-certification/pre-authorization
Coverage policy and pre-certification/pre-authorization information for out-of-area members.
View coverage policyCoverage policy
Quickly search for coverage information using a keyword, procedure code, policy number or title.
View coverageProviders' News
Find updates on the latest policies and procedures for providers.
Read Providers' NewsPrior Approval Information for Radiological Services
Information to assist providers in filing claims, referral requests and other services.
View moreElectronic Data Interchange (EDI)
Your resource for the Health Insurance Portability and Accountability Act (HIPAA) requirements and testing.
View EDIPrior Approval Guide for Metallic Policies
Use this guide to see prior approval information for members with ID card prefixes: AEE, AXC, EXX, XCB, XCQ, XCR
View guidesPrescription drug prior approval [pdf]
Access the Standard/Standard with Step Therapy drug list for your patients.
View drug list