News
Ambetter Providers - Clinical and Payment Policy Changes
Date: 07/01/18
Peach State Health Plan is publishing its Payment and Clinical Policies to inform providers about acceptable billing practices and reimbursement methodologies for certain procedures and services. We will apply these policies as medical claims reimbursement edits within our claims adjudication system. This is in addition to all other reimbursement processes that Peach State Health Plan currently employs.
The effective date for the below policies is July 1, 2018
The policies can be found by going to the Clinicial & Payment Policies page on our website:
Ambetter from Peach State Health Plan Clinical & Payment Policies
Number | Policy Name | Policy Description | Product |
|---|---|---|---|
CP.MP.152 | Measurement of Serum 1,25-dihydroxyvitamin D |
This policy address when measurement of 1,25(OH)2D is appropriate and medically necessary.
|
Ambetter, Medicare |
CP.MP.153 | Helicobacter Pylori (H. pylori) Serology Testing |
This policy outlines why serologic antibody testing cannot distinguish between an active infection and a past infection, and why alternative, non-invasive testing methods (e.g., the urea breath test and stool antigen test) exist for detecting the presence of H. pylori. |
Ambetter, Medicare |
GA.CP.MP.154 |
Insulin Testing in Pediatrics |
This policy discusses the medical necessity requirements for the insulin testing in pediatrics. |
Ambetter |
CP.MP.155 | EEG in the Evaluation of Headache | This policy addresses the use of EEG in the diagnostic evaluation of headache. |
Ambetter, Medicare
|
CP.MP.156 | Cardiac Biomarker Testing for Acute Myocardial Infarction | This policy discusses the medical necessity requirements for testing of cardiac biomarkers. |
Ambetter, Medicare |
CP.MP.157 | 25-hydroxyvitamin D Testing in Children and Adolescents | The policy outlines the recommendations against universal screening for vitamin D deficiency in healthy children. |
Ambetter |
CC.PP.052 |
Problem Oriented Visits with Surgical Procedures | The purpose of this policy is to define payment criteria for problem-oriented visits when billed on the same day as a surgical procedure to be used in making payment decisions and administering benefits.
|
Ambetter |
CC.PP.054 |
Physician's Consultation Services | The purpose of this policy is to define payment criteria for consultation services to be used in making payment decisions and administering benefits.
|
Ambetter |
CC.PP.056 |
Urine Specimen Validity Testing | The purpose of this policy is to define payment criteria for urine specimen validity testing to be used in making payment decisions and administering benefits. |
Ambetter, Medicare |
CC.PP.057 |
Problem Oriented Visits with Preventative Visits | The purpose of this policy is to define payment criteria for problem-oriented visits when billed with preventative visits to be used in making payment decisions and administering benefits.
|
Ambetter |