Our participating providers and facilities agree to bill us directly for covered services provided to our members in accordance with their participating agreement.

All providers that are eligible to contract with us must bill for all services they perform under their own name. A licensed provider may not submit claims for services performed by and on behalf of (i.e., incident to) another provider or Non-Physician Practitioner (NPP). Behavioral health and palliative care services are exceptions to this.

We do not accept claims for, or provide coverage for, services rendered as part of a residency or fellowship program. Claims should not be submitted under the name and identifier of the attending or supervising provider.

Patient eligibility and benefits should be verified through Availity Essentials.

• Patients may be asked for estimated copayment, deductible or coinsurance at the time of service.

• After services are rendered, the patient should only be billed for any remaining deductible, copayment and/or coinsurance amounts not collected and non-covered services.

Centers for Medicare & Medicaid Services (CMS) provides regulations and guidance on correct billing and coding use.