Biblioteca de boletines de políticas
HPP's policy bulletins communicate our medical, claim payment reimbursement, and drug positions for services administered in relation to the applicable member’s benefits.
We have created three sections of the library below: medical policies, claim payment polices, and drug policies.
All policy documents are considered complementary to our Provider Manual.
Medical Policy Bulletins
Our Medical policy bulletins define medical necessity criteria and coverage positions on topics such as medical services, procedures, DME, therapies, etc.
|
Policy Bulletin # |
Title |
Summary |
Version Date |
| MN.004.C | de tecnología nueva | Documents our coverage position for new technologies | 6/3/2024 |
| MN.005.D | Experimental and Investigational Services, Investigational Device Exemption (IDE), and Coverage with Evidence Development (CED) | Documents our coverage position for E&I Services, IDEs, and CEDs | 8/21/2024 |
| MN.006.I | Cosmetic & Reconstructive Services | Documents our coverage position for cosmetic and reconstructive services | 4/17/2024 |
| MN.008.C | Genetic Testing | Documents our coverage position on genetic testing | 7/1/2020 |
| MN.010.G | Gender Confirmation Surgery | Documents our position on gender confirmation surgery | 7/18/2024 |
|
MN.011.D |
Documents our coverage position on WGS and WES |
12/1/2023 |
|
|
MN.013.D |
Documents our position on the shift care, personal care, and medical daycare |
11/1/2023 |
|
| MN.015.B | Standards of Medical Necessity | Documents our position related to medical necessity | 9/1/2021 |
| MN.016.A | Injectable/Specialty Drugs Prior Authorization Requirements | Documents our prior authorization requirements for injectable/specialty drugs | 12/1/2019 |
| MN.020.B | Peroral Endoscopic Myotomy (POEM) | Documents our position related to Peroral Endoscopic Myotomy (POEM) | 3/1/2022 |
| MN.021.A | Panniculectomy and Abdominoplasty | Documents our position related to panniculectomy and abdominoplasty | 2/1/2023 |
| MN.022.A | Reduction Mammoplasty | Documents our position related to reduction mammoplasty | 8/1/2023 |
Medical Policy Type Key: MN = Medical Necessity
Claim Payment Policy Bulletins
Our Claim Payment policy bulletins provide reimbursement rules and billing guidelines necessary to ensure timely and appropriate payment.
|
Policy Bulletin # |
Title |
Summary |
Version Date |
| RB.001.D | Ambulance Ground Mileage Claim | Documents our reimbursement rules for ambulance ground mileage and ambulance services | 7/1/2024 |
| RB.004.A | Modifier 50, Bilateral Procedure | Documents our position on modifier 50, bilateral procedure | 3/31/2016 |
| RB.005.A | Modifier 25 | Documents our position on Modifier 25 | 7/1/2016 |
| RB.006.C | STAT Labs | Provides reporting requirements and reimbursement rules for STAT laboratory tests (a.k.a. labs) | 1/1/2023 |
| RB.007.C | DME Continuous Rental | Documents our position on durable medical equipment (DME) rentals | 6/1/2024 |
| RB.009.A | Sepsis and Severe Sepsis DRG Clinical Validation Review | Documents our position on Sepsis and Severe Sepsis DRG Clinical Validation review | 4/1/2020 |
| RB.014.C | Observation Care
Preguntas frecuentes |
Documents our position on Observation Care services
Provides answers to common questions |
2/1/2022 |
| RB.015.C | Cataract Removal and Related Ophthalmologic Testing | Documents our position on cataract removal and related ophthalmologic testing | 5/1/2022 |
| RB.017.C | Continuous Glucose Monitors | Documents our position on continuous glucose monitors | 12/9/2022 |
| RB.018.A | Medicare Readmissions | Documents our position on Medicare readmissions | 1/1/2021 |
| RB.019.A | Health Care Acquired Conditions (HCAC) and Preventable Serious Adverse Events (PSAE) | Documents our position on Health Care Acquired Conditions and Preventable Serious Adverse Events | 1/1/2021 |
| RB.020.A | Obstetric Anesthesia Services |
Documents our position on obstetric anesthesia services. |
12/1/2021 |
| RB.021.A | Professional Telehealth Services (Medicare) |
Updates our policy on telehealth services, specifically for Medicare members. |
1/1/2022 |
| RB.022.C | Rapid Hemoglobin A1c (HbA1c) Testing |
Documents our position on rapid hemoglobin A1c (HbA1c) testing. |
3/13/2023 |
| RB.023.B | Diabetic Retinopathy Screening and Fundus Photography |
Documents our position on diabetic retinopathy screening and fundus photography. |
12/9/2022 |
| RB.024.A | Professional Telehealth Services (Medicaid and CHIP) |
Updates our policy on telehealth services for Medicaid and CHIP members. |
8/1/2022 |
|
RB.025.D |
Pediatric Shift Care When Multiple Members in a Household Are Receiving Care |
Documents our position on pediatric shift care when multiple members in a household are receiving care. |
11/1/2023 |
| RB.026.A | Remote Patient Monitoring |
Provides information on remote patient monitoring. |
10/14/2022 |
| RB.027.A | Tobacco Cessation Program |
Provides information on tobacco cessation certification. |
7/1/2022 |
| RB.028.A | CMS and DHS Payment Systems Update and Maintenance Payment Policy |
Provides information on CMS and DHS policies. |
3/1/2022 |
| RB.029.B | Programa de prevención de la diabetes |
Provides information on the Diabetes Prevention Program |
5/8/2023 |
| RB.030.B | Newborn Authorizations |
Provides information on authorizations for newborns |
9/18/2024 |
| RB.031.A | Maternity Billing and Reimbursement Guidelines |
Provides information on authorizations for maternity billing and reimbursement |
5/15/2023 |
| RB.032.A | Adjudication of Claims from Non-Participating Providers |
Documents our coverage position for Adjudication of claims for non participating providers |
9/29/2023 |
|
RB.033.B |
Provides information on vaccine coding and administration |
12/20/2023 |
|
|
RB.034.A |
Adjudication of Medicare Claims from Non-Participating Providers |
Provides our policy on claims process |
1/1/2024 |
|
RB.035.A |
Provides our position on preventative care services |
1/1/2024 |
|
|
RB.037.A |
Readmissions (Individual and Family Plans) |
Updates our policy on readmissions. |
1/1/2024 |
|
RB.038.A |
Professional Telehealth Services (Individual and Family Plans) |
Updates our policy on telehealth services, specifically for IFP members. |
1/1/2024 |
|
RB.039.A |
Updates our policy on requirements for anesthesia services. |
10/16/2024 |
Claim Payment Policy Type Key: RB = Reimbursement
Drug Policy Bulletins
Our Drug policy bulletins documents our position on pharmaceutical topics and drugs.
|
Policy Bulletin # |
Title |
Summary |
Version Date |
| DR.002.F | Inmunoglobulina intravenosa (IVIG) | Documents our position regarding IVIG Therapy. |
9/18/2023 |
| DR.003.D | Ocrevus (Ocrelizumab) | Documents our position on Ocrevus (Ocrelizumab). | 4/24/2023 |
| DR.004.E | Spinraza (Nusinersen) | Documents our position on Spinraza (Nusinersen). | 4/24/2023 |
|
DR.005.D |
Documents our position on Zolgensma (onasemnogene abeparvovec-xioi). |
4/17/2024 |
|
|
DR.006.D |
Complement Inhibitors: Eculizumab (Soliris) & Ravulizumab (Ultomiris) |
Documents our position on Eculizumab (Soliris) and Ravulizumab (Ultomiris). |
12/1/2023 |
|
DR.007.C |
Documents our position on Adakveo (Crizanlizumab-tcma). |
11/1/2023 |
|
| DR.008.B | Sandostatin LAR Depot (octreotide acetate) | Documents our position on Sandostatin LAR Depot (octreotide acetate). | 9/1/2023 |
| DR.009.C | TEPEZZA® (teprotumumab-trbw) | Documents our position on TEPEZZA (teprotumumab-trbw). | 8/21/2024 |
| DR.010.C | Xiaflex (Collagenase clostridium histolyticum) | Documents our position on Xiaflex (Collagenase clostridium histolyticum). | 9/1/2023 |
|
DR.011.D |
Documents our position on IgG1 Monoclonal Antibodies for Alzheimer’s |
5/15/2024 |
|
| DR.013.B | Relizorb (immobilized lipase) Cartridge | Documents our position on Relizorb (immobilized lipase). | 3/20/2024 |
| DR.015.A | ROCTAVIAN™ (valoctocogene roxaparvovec-rvox) | Documents our position on ROCTAVIAN (valoctocogene roxaparvovec-rvox). | 5/15/2024 |
| DR.016.A | ELEVIDYS® (Delandistrogene moxeparvovec-rokl) | Documents our position on RELEVIDYS. | 7/1/2024 |
| DR.017.A | Adstiladrin® (Nadofaragene firadenovec-vncg) | Documents our position on Adstiladrin (Nadofaragene firadenovec-vncg). | 7/1/2024 |
| DR.018.A | Viltepso® (Viltolarsen) | Documents our position on Viltepso (Viltolarsen). | 7/1/2024 |
| DR.019.A | Hemgenix® (Etranacogene dezaparvovec-drlb) | Documents our position on Hemgenix (Etranacogene dezaparvovec-drlb). | 7/1/2024 |
| DR.020.A | Casgevy® (exagamglogene autotemcel) | Documents our position on Casgevy (exagamglogene autotemcel). | 8/21/2024 |
| DR.021.A | Lyfgenia™ (lovotibeglogene autotemcel) | Documents our position on Lyfgenia (lovotibeglogene autotemcel). | 8/21/2024 |
| DR.022.A | Zynteglo™ (betibeglogene autotemcel) | Documents our position on Zynteglo(betibeglogene autotemcel). | 8/21/2024 |
Drug Policy Type Key: DR = Drug
Tenga en cuenta que:
- The effective date of select policy bulletins found in the Policy Bulletin Library above may considerably pre-date the actual date of their availability on this Policy Bulletin Library web page. This is because the Policy Bulletin Library will include PDFs of policies that have been in effect for many years, but have not been previously published on our website.
- New and updated policy bulletins will typically be published in the Policy Bulletin Library 30 to 60 days prior to their implementation date, ensuring that your office is given appropriate notification of changes and updates that may affect your office.
