Guidelines for applying HMSA medical policies to medical pharmacy services, including precertification, quantity limits, and documentation requirements for drugs and DME.

Medicare health plans must issue the Notice of Denial of Medical Coverage (or Payment) also known as the Integrated Denial Notice (IDN) Form CMS-10003-NDMCP when an enrollee's request for coverage is denied and when a previously authorized course of treatment has ended or been reduced.

Find tools and information to verify member eligibility, review coverage details, and understand benefits to help manage health plans effectively.

Learn about HMSA member rights, privacy protections, and responsibilities, including Medicare safeguards and how personal and health information is protected

Access the HMSA Membership Verification Line to quickly confirm member eligibility and coverage details 24/7 using provider and patient information.

Learn billing guidelines and coverage details for multiple endoscopy procedures, including reimbursement rules, coding requirements, and key policy considerations.

Learn what a National Provider Identifier (NPI) is, who needs one, and how to apply, update, or use your NPI for healthcare billing and compliance.

Learn about nerve conduction studies, how they diagnose nerve damage, what to expect during testing, and how results guide treatment decisions.

Learn about newborn delivery hospital stay with dual coverage, including primacy determination and coordination of benefits (COB) for accurate claims processing.

Learn about newborn delivery hospital stay, dual membership primacy, and coordination of benefits (COB) for accurate coverage and claims processing.