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Providers

Provider Manual

Your source for commonly asked questions about healthcare coverage, claims procedures, policies and more.

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Coverage policy

Quickly search for coverage information using a keyword, procedure code, policy number or title.

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Providers' News

Find updates on the latest policies and procedures for providers.

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Coverage policy and pre-certification/pre-authorization

Coverage policy and pre-certification/pre-authorization information for out-of-area members.

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Prior Approval Information for Radiological Services

Information to assist providers in filing claims, referral requests and other services.

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Electronic Data Interchange (EDI)

Your resource for the Health Insurance Portability and Accountability Act (HIPAA) requirements and testing.

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Prior 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

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Prescription drug prior approval

Access the Standard/Standard with Step Therapy drug list for your patients.

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Medicare plans

Learn more about providing care for Medicare members.

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