Pain Management Practice Offices - Billing and Coding for Drug Testing Payers' Policy, Documentation and Utilization Guidelines are all here! DISCLAIMER: Below are payers' guidelines and policy that we have been using primarily for compliance, medical necessity and utilization guidelines. These policy serves as our guide in all that we do in revenue cycle management, patients access and prior authorization process and we are sharing this to our provider, group and facility clients. All these payer guidelines and the contents on this page are from its own sources and public web portals domain. It is always your responsibility to contact your local carriers, commercial payers, claims adjusters and case managers should you have any questions and any concerns regarding medical necessity policy and determination including utilization and medical/surgical frequency guideline. Reimbursement and clinical guideline questions should always be given to your payers and obtain information/answers from your insurance payers. Local Coverage Determination, Medical Policy and Guideline Read the Coverage Guidance:
Medicare Part B CaliforniaMedicare Part B FloridaMedicare Part B HawaiiMedicare Part B IndianaMedicare Part B IowaMedicare Part B KansasMedicare Part B MichiganMedicare Part B MissouriMedicare Part B New JerseyMedicare Part B New YorkMedicare Part B NebraskaMedicare Part B NevadaMedicare Part B North Carolina Medicare Part B South CarolinaMedicare Part B Washington State
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DISCLAIMER: Below are payers' guidelines and policy that we have been using primarily for compliance, medical necessity and utilization guidelines. These policy serves as our guide in all that we do in revenue cycle management, patients access and prior authorization process and we are sharing this to our provider, group and facility clients. All these payer guidelines and the contents on this page are from its own sources and public web portals domain. It is always your responsibility to contact your local carriers, commercial payers, claims adjusters and case managers should you have any questions and any concerns regarding medical necessity policy and determination including utilization and medical/surgical frequency guideline. Reimbursement and clinical guideline questions should always be given to your payers and obtain information/answers from your insurance payers. Medicare Part B New JerseyMedicare Part B CaliforniaMedicare Part B ConnecticutMedicare Part B HawaiiMedicare Part B New YorkMedicare Part B IllinoisMedicare Part B IndianaMedicare Part B KansasMedicare Part B MaineMedicare Part B MissouriMedicare Part B NevadaMedicare Part B North CarolinaMedicare Part B Rhode IslandMedicare Part B South Carolinalocal_coverage_determination_for_facet_joint_injections_medial_branch_blocks_and_facet_joint_radiofrequency_neurotomy__l35996__mcr_mo.pdfFacet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy (L36471) Medicare Part B WisconsinFor what you don't know may hurt you... always look for answers and always do the right thing. Aetna HealthcareAnthem Blue Cross Blue Shield of CaliforniaAnthem Blue Cross Cryoneurolysis for Treatment of Peripheral Nerve Pain-SURG.00155 Anthem Blue Cross Implanted Devices for Spinal Stenosis-DME.00025 Anthem Blue Cross Blue Shield of ColoradoAnthem Blue Cross Blue Shield of GeorgiaAnthem Blue Cross Blue Shield of IndianaAnthem Blue Cross Blue Shield of KentuckyAnthem Blue Cross Blue Shield of MaineAnthem Blue Cross Blue Shield of MissouriAnthem Blue Cross Blue Shield of NevadaAnthem Blue Cross Blue Shield of New YorkAnthem Blue Cross Blue Shield of WisconsinBlue Cross Blue Shield of KansasBlue Cross Blue Shield of New JerseyBlue Cross Blue Shield of MissouriBlue Cross Blue Shield of North CarolinaBlue Cross Blue Shield of South CarolinaCentene PolicyCigna HealthcareDISCLAIMER: Below are payers' pre-certification and prior authorization forms that are made available for the Providers. Our company is using most of these forms. Our company process thousands of cases for pain management and spinal orthopedic surgeries. All these forms are from its payers public web portals domain. It is always your responsibility to contact your local carriers, commercial payers, claims adjusters and case managers should you have any questions and any concerns regarding precertification and or prior authorization process. Aetna Healthcare Prior Authorization FormsAetna Healthcare Dorsal Column Stimulator Precertification Request Form Aetna Healthcare Spinal Surgery Precertification Form Aetna Healthcare Hip Surgery Impingement Syndrome Precertification Form Aetna Healthcare Shoulder Arthroplasty Precertification Form Blue Cross Blue Shield NJBlue Cross Blue Shield KansasBlue Cross Blue Shield North Carolina Blue Cross Blue Shield Knee Orthosis Prior Authorization Form BlueCross BlueShield Lumbar Sacral Orthosis/Thoracic Lumbar Sacral Orthosis Prior Authorization Form Blue Cross Blue Shield South CarolinaBlue cross Blue Shield MissouriCigna Healthcare |
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Denial Management
Motor Vehicle Cases
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Prior Authorization Process
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Prior-to-insurance eligibility and coverage verification
Utilization and medical policy review
Medical necessity evaluation and screening
Financial clearance process
Patients Access
Patients Registry and Initial Demographic Entry
Patients Scheduling and Confirming Appointments
Coordination of prior-to-encounter orders management
Prior-to-encounter insurance verification
Obtaining Referral
Obtaining Prior Authorization
Obtaining Peri Operative Orders
Financial Counseling
Insurance Credentialing and Contracting
Payers' Contract Fees Negotiations
Documentation Review
Evaluation and Management Coding Review
Surgical Coding Review
Compliance Program
Office and Surgical Scheduling
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