The purpose of medical policy is to provide guidelines for determining coverage criteria for specific procedures, equipment and services. The Introduction section of this manual includes information about:
- Approval process
- Research sources
- Definition of medical necessity
- Technology assessment process
- Definition of investigational services
Selecting of technologies for policy development
Reimbursement policy documents our payment policy and correct coding for medical and surgical services and supplies. It is used to provide consistent and predictable claims payment through the systematic application of our member contracts, provider agreements and medical policies.
Dental policies have been developed through consideration of government approval status, dental necessity, generally accepted standards of dental practice and review of dental literature.
We publish updates to dental reimbursement policies in our newsletter, The Connection.
Medication policies are based upon research of scientific literature, government approval status, and evidence-based treatment guidelines supporting clinical best practice/standards of care.
- Commercial medication policies
- Medicare Basic Plan medication policies
Clinical Practice Guidelines (CPGs) are systematically developed statements on medical practices that help physicians and other practitioners make decisions about appropriate health care for specific medical conditions.