Wiki reimbursement policies from insureres

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Korbc

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Hello,
I'm new to coding and was wondering if anyone could tell me how to access insurers reimbursement policies? or where to navigate on their website or how to request that information? I live in CT. Thanks!
 
camillekorb said:
Hello,
I'm new to coding and was wondering if anyone could tell me how to access insurers reimbursement policies? or where to navigate on their website or how to request that information? I live in CT. Thanks!
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Most insurance companies have different resources for Members and Providers linked on their websites. The clinical payment/reimbursement policies will generally be listed under the provider resources section from the insurer's main website.

For example, Aetna calls the documents Clinical Policy Bulletins and you can find them under the provider resources section. Here's a direct link as well: https://www.aetna.com/health-care-professionals/clinical-policy-bulletins.html

This is the direct link for United Healthcare's provider section: https://www.uhcprovider.com/en/policies-protocols.html

Many insurers also have a search bar on top of the website - sometimes I'll just pop a CPT code in that box and see what resources come up & research from there.

Be sure to pay attention to whether the policy is labeled as applicable to Commercial, Medicare, and/or Medicaid patients. There could be different rules for each type of plan.
 
sls314 said:
Most insurance companies have different resources for Members and Providers linked on their websites. The clinical payment/reimbursement policies will generally be listed under the provider resources section from the insurer's main website.

For example, Aetna calls the documents Clinical Policy Bulletins and you can find them under the provider resources section. Here's a direct link as well: https://www.aetna.com/health-care-professionals/clinical-policy-bulletins.html

This is the direct link for United Healthcare's provider section: https://www.uhcprovider.com/en/policies-protocols.html

Many insurers also have a search bar on top of the website - sometimes I'll just pop a CPT code in that box and see what resources come up & research from there.

Be sure to pay attention to whether the policy is labeled as applicable to Commercial, Medicare, and/or Medicaid patients. There could be different rules for each
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Thank you so much! this was so helpful!
 
camillekorb said:
thanks so much, i went to click one of them but nothing pops up, not sure if that's the same for you? it looks like a great tool though
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Sometimes an insurer might update a link slightly, so the direct link to the payer's policies could be broken.

I suspect the first column with the insurer's main home page will stay pretty consistent though - you could always use that as a navigation starting point for the insurer's site and then get to the provider resources from there.

(I thought there used to be a report form to get a link corrected but I'm not sure where it is.)
 
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