Working with HMSA
Coordination of Benefits – Two HMSA Plans
Guidelines for coordination of benefits for members with two HMSA plans, including primacy determination and automatic claims processing.
Coordination of Benefits for Pharmacy Services
Guidelines for coordination of benefits for pharmacy services, including primary payer determination, coverage rules, and claims processing requirements.
Coordination of Benefits with Medicare
Understand coordination of benefits with Medicare, including primary vs. secondary payer rules, coverage after Medicare payments, and billing requirements for facility claims.
Critical Care
Guidelines for critical care services, including coverage, billing requirements, and reimbursement guidelines for intensive patient care.
Defibrillator – Senior Plans
Guidelines for defibrillator services under senior plans, including coverage, billing requirements, and reimbursement guidelines.
Diabetes Education
Guidelines for diabetes education services, including coverage, eligible services, and requirements under HMSA plans.
Diabetic Education – FEP Postal Services Health Benefits (PSHB) Program
Learn about diabetic education for FEP and PSHB members, including self-management training, preventive care, and resources for living with diabetes.
Dispense as Written (DAW)
Guidelines for Dispense as Written (DAW) codes, including billing requirements, substitution rules, and reimbursement considerations for pharmacy claims.
Dispense as Written (DAW) Documentation
Guidelines for Dispense as Written (DAW) documentation, including requirements for DAW 1 and DAW 2 codes and acceptable supporting records for claims.
Drug Report to Member Audits
Guidelines for drug report to member audits, including audit requirements, review processes, and documentation for pharmacy claims.