Claims Billing Manual

The Claims Billing Manual provides guidance for billing both professional (CMS-1500) and institutional (UB04) paper and electronic claims. It is not intended to be a comprehensive document of all policies and procedures. 

Claims Compliance

Understand the laws pertaining to the prevention and detection of fraud, waste, and abuse, in accordance with the requirements of the federal Deficit Reduction Act of 2005.

Claims and Refunds

Learn where to send refunds for errors in claims payments.

Claims Payment Dispute

Learn how to submit a payment dispute.

Electronic Claims Submission and Electronic Funds Transfer (EFT) / Electronic Remittance Advise (ERA)

Observation Authorization

Prior authorization is required for elective and direct placement into observation (i.e. from home, physician office, etc.)


Information current as of: