News
New Policies Effective June 1, 2022.
Date: 07/28/22
Thank you for your continued partnership with Ambetter. As you know, we continually review and update our payment and utilization policies to ensure that they are designed to comply with industry standards while delivering the best patient experience to our members. We are writing to inform you of new policies Ambetter has implemented effective 6/1/2022.
Policy Number | Policy Name | Policy Description | Lines of Business |
|---|---|---|---|
CC.PP.071 | Evaluation and Management Services Billed with Treatment Rooms | Based on correct coding principles, this policy disallows E&M services in treatment rooms as this does not represent a specific treatment type of service. Also disallows for hospital facility charges representing treatment room services when the service provided is not a treatment. | MMP Marketplace |
CC.PP.068 | Multiple Procedure Payment Reduction for Therapeutic Services | When multiple (two or more) ‘always therapy’ procedures with an MPI of 5 are performed by the same provider, or by providers within the same group practice, on the same day, the policy will allow 100% of the maximum allowance for the therapeutic procedure with the highest cost per until and 90% of the allowance for each subsequent therapeutic procedure. | MMP Marketplace |
For detailed information about these policies, please refer to our website at www.ambettermeridian.com. And for questions about this or any of our payment policies, please don’t hesitate to reach out to our Provider Services team at 1-888-993-2426.