Current Policies

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The Health Plan recognizes that providers may be experiencing a decrease in revenue due to practice restrictions that have been established in response to the COVID-19 pandemic. We are working hard to improve the turnaround time for claims processing and payment for Commercial, Medicare and Medicaid claims.

During the COVID-19 pandemic, temporary measures were implemented to accelerate provider payments in order to allow for faster access to funding. These temporary measures do not pertain to self-funded groups. Should you require claims assistance, please feel free to contact us at 1.800.624.6961 or contact the practice management consultant assigned to your county.

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A

• Air Ambulance Transportation

C

• COVID-19 Testing
• COVID-19 Vaccine and Administration

E

• Early and Periodic Screening, Diagnostic and Treatment (EPSDT)

H

• Hospital Readmission Occurring within 30 Days of an Index Admission

N

• Never Events, Adverse Events, Hospital Acquired Conditions, Serious Reportable Conditions & Provider Preventable Conditions  
• Non-Covered / Non-Reimbursable Codes

O

• Outpatient Hospital Laboratory Pass Through Billing 

P

• Prepayment Review Process - Mountain Health Trust (Medicaid & CHIP)

R

• Robot Assisted Surgery