Reimbursement Policies
AmeriHealth Caritas VIP Care Plus reimbursement policies and their resulting edits are based on guidelines from established industry sources, such as the Centers for Medicare and Medicaid Services (CMS), the American Medical Association (AMA), state and federal regulatory agencies, and medical specialty professional societies. Reimbursement policies are intended as a general reference and do not constitute a contract or other guarantee of payment. AmeriHealth Caritas VIP Care Plus may use reasonable discretion in interpreting and applying its policies to services provided in a particular case and may modify its policies at any time.
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A
- Acupuncture
- Add-On Codes
- Allergy Testing
- Ambulance Services
- Ambulatory Surgery Center
- Anatomical Modifiers
- Anesthesia
- Assistant Surgeon
- Audiology and Hearing Aids
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B
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C
- Cardiology Services
- Cerumen Removal
- Chiropractic Services
- Co-Surgeon
- Colonoscopy .pdf
- Cost Outlier Payment
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D
- Dermatology
- Diagnosis Procedure Age Guidelines
- Diagnosis Procedure Code Gender Guidelines
- Discarded Drugs and Biologicals
- Discontinued Procedures
- Distinct Procedural Service
- Duplicate Services
- Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
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E
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F
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G
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H
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I
- Implants and Devices
- In-Office Stat Labs
- Inappropriate Diagnosis Coding
- Incident To
- Investigational-Experimental Procedures
- Itemized Bill Review
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K
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L
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M
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N
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O
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P
- Place of Service
- Post Payment Review
- Preventive Services
- Procedure Code Guidelines
- Professional Technical Components
- Provider Administered Drugs-National Drug Code (NDC) .pdf
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Q
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R
- Readmissions
- Repeat Procedure Modifiers 76 and 77 .pdf
- Request for Medical Records
- Review for Potential Upcoding of Services
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S
- Significant-Separately Identifiable Evaluation and Management Service
- Sleep Studies
- Split Billing Guidelines
- Submission of Claims .pdf
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T
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U
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V
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