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Good Morning
9:50:52 AM CDT
Friday, October 31, 2014

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This information is a resource to use in conjunction with Provider News, the Utilization Review Guide and other publications. It is subject to change at any given time without notice. Coverage decisions are subject to claims decisions, fee schedule guidelines and applicable state laws. Information contained in this section does not constitute authorization of services.

Processing of medical bills includes assessment of the following:
  • Timely filing
    • Within one year from date of service, or
    • Within one year from date liabilty was accepted
  • Medical relatedness and necessity to the accepted injury
  • Medical documentation support of the billed charge
  • Accuracy of charges, codes and modifiers
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  • Compliance with the 1997 coding guidelines for Evaluation