Claims & Billing
Explore claims and billing resources, including filing requirements, payment guidelines, and coverage information.
Refill Too Soon Edit
Learn about the Refill Too Soon edit, including claim rejection rules, refill timing limits, override options, and how to ensure accurate pharmacy claims.
Resubmission of Claims (CMS-1500)
Guidelines for resubmitting CMS‑1500 claims, including claim status verification, corrected claim requirements, and documentation for accurate processing.
Services from the Radiology Section of CPT Billed with Other Services
Understand how radiology CPT services are billed with other procedures, including bundling rules, modifiers, and guidelines for accurate, compliant claims.
Standby Services
Learn about HMSA standby services, including coverage details, eligibility, and billing guidelines for providers and patients. Explore policies and requirements.
Surgery – Claim Documentation Requirements
Guidelines for surgery claim documentation, including required clinical records, operative reports, and supporting documentation for accurate claim processing and reimbursement.
Surgical Services from the 10000 Series of CPT Billed with Other Services
Learn HMSA guidelines for surgical services from the 10000 CPT series billed with other services, including coverage, coding rules, and reimbursement policies.
Surgical Services from the 20000 Series of CPT Billed with Other Services
Learn HMSA guidelines for surgical services from the 20000 CPT series billed with other services, including coverage, coding rules, and reimbursement policies.
Surgical Services from the 30000 Series of CPT Billed with Other Services
Learn HMSA guidelines for surgical services from the 30000 CPT series billed with other services, including coverage, coding rules, and reimbursement policies.
Surgical Services from the 40000 Series of CPT Billed with Other Services
Learn HMSA guidelines for surgical services from the 40000 CPT series billed with other services, including coverage, coding rules, and reimbursement policies.
Surgical Services from the 50000 Series of CPT Billed with Other Services
Learn HMSA guidelines for surgical services from the 50000 CPT series billed with other services, including coverage, coding rules, and reimbursement policies.