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(904) 363-5870
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Overview
──────────
News
Bluemail
Bulletins & FAQs
──────────
Forms
Availity Log-in
Availity Online Services
Provider Manual
──────────
Programs
Advance Care Planning
CMS Member Survey Experience
Federal Employee Program
Kidney Health Management
Quality: HEDIS & PQA Measures
Quality: Medicare Stars
Quality: Readmissions Review
Risk Adjustment
Utilization Management
Value-Based Alternative Payment
──────────
──────────
Medical & Pharmacy Policies
Dental Information
Medical Policies (Medical Coverage Guidelines)
Medication Guide
Medical Policy, Pre-Certification, Pre-Authorization
Part B Step Therapy
Pharmacy Utilization Management
Practice & Preventive Service Guidelines
Prior Authorization
Specialty Pharmacy
──────────
Payment Policies
Billing
Companion Documents
Online Training
──────────
Behavioral Health
Behavioral Health Ecosystem
Measurement-Based Care in Behavioral Health
Psychotherapeutic Medication Guidelines
Virtual Treatment
Advocacy Resources
──────────
──────────
Pain Management
Chronic Pain Management
Opioid Addiction & Overdose Medication
──────────
Temporary Insurance
Payment Policies
Payment Policies
File Name
Format
Updated
3D Rendering of Tomographic Modalities
PDF
October 2023
Add On Codes
PDF
July 2024
Administration of Injections and Infusions in Facility Settings
PDF
September 2023
After Hours and Weekend Care
PDF
March 2024
Ambulance Services
PDF
July 2024
Anatomical Modifier Requirement Policy NEW
PDF
October 2023
Anesthesia Services
PDF
June 2024
Bilateral Procedures - Professional & Institutional Billing
PDF
October 2023
B-Status Codes
PDF
November 2023
Care Coordination Services
PDF
February 2024
Consultation Services
PDF
May 2024
Co-Surgeons (Two Surgeons)
PDF
September 2023
Discontinued Procedure-53 Modifier
PDF
April 2024
Evaluation & Management for Office or Other Outpatient Services
PDF
January 2024
Evaluation & Management Services by Physicians in the Same Group Practice
PDF
June 2024
Facility Reimbursement for Clinic Services
PDF
December 2023
Global Surgery Package
PDF
October 2023
Hospital Related Services for or Leading to an Inpatient Admission
PDF
August 2024
Hospital Related Services for Outpatient Claims
PDF
December 2023
Increased Procedural Services (Modifier-22)
PDF
June 2024
Initial Hospital Inpatient or Observation Evaluation & Management Services
PDF
July 2024
Institutional Payment Programs and Charge Based Reimbursement for Commercial Products
PDF
September 2023
Institutional Reimbursement as Inpatient versus Outpatient NEW
PDF
August 2023
Institutional Supplies Policy
PDF
March 2023
Laboratory Panels and Components
PDF
May 2024
Maximum Units of Service
PDF
November 2023
Modifier Reference
PDF
April 2024
Multiple Diagnostic Cardiovascular Procedure Reduction
PDF
August 2024
Multiple Diagnostic Cardiovascular Procedure Reduction
*ARCHIVE*
PDF
August 2023
Multiple Diagnostic Ophthalmology Procedure Reduction
PDF
August 2024
Multiple Diagnostic Ophthalmology Procedure Reduction
*ARCHIVE*
PDF
August 2023
Multiple Imaging Reduction
PDF
August 2024
Multiple Imaging Reduction
*ARCHIVE*
PDF
August 2023
Multiple Procedure Reduction - Home Infusion Therapy Per-Diem
PDF
August 2024
Multiple Surgical Procedure Reduction (Including Multiple Endoscopic Procedure Reduction)
PDF
August 2024
Multiple Therapy Reduction
PDF
August 2024
Multiple Visit Reduction
PDF
August 2024
National Correct Coding Initiative
PDF
July 2024
Never Event – Hospital Acquired Condition (HAC) in Inpatient Setting
PDF
August 2024
Never Events - Wrong Surgery
PDF
July 2024
New Patient Visits
PDF
June 2024
NonPhysician Healthcare Professionals Billing E-M Codes
PDF
January 2024
Hospital Inpatient or Observation Discharge Policy
PDF
September 2023
Outpatient Facility Alternate Procedure Code Reimbursement NEW
PDF
August 2024
Obstetric Services
PDF
February 2024
Physical Therapy Assistant and Occupational Therapy Assistant Services *NEW*
PDF
October 2024
Portable X-Ray and EKG Supplier Services
PDF
July 2024
Professional Technical Component
PDF
September 2023
Prolonged Services
PDF
April 2024
Readmissions Review Quality Program for MA & Comm
PDF
December 2023
Reduced Services-52 Modifier
PDF
April 2024
Reporting Habilitative and Rehabilitative Services
PDF
September 2023
Robotic Assisted Surgery
PDF
April 2024
Robotic Assisted Surgery Facility Policy
PDF
April 2024
Split Surgical Package
PDF
October 2023
Standby Services
PDF
March 2024
Supplies
PDF
October 2023
Surgical Assistant
PDF
November 2023
Telehealth Facility Procedure Q3014
PDF
January 2024
Third Party Billing When a Member is Inpatient
PDF
December 2023
T-Status Codes
PDF
May 2024
Unbundled, Incidental, and Mutually Exclusive Services
PDF
November 2023
Unclassified Drugs
PDF
May 2024
Unlisted Procedure Codes
PDF
May 2024
Virtual Visits
PDF
January 2024