Working with HMSA
2026 Primary Care Payment Model – Provider Resources and Full Code Sets
Explore the Primary Care Payment Model full code set for 2026, including eligible codes, billing requirements, reimbursement guidelines, and payment policies.
Accessibility Standards
Learn about HMSA accessibility standards and requirements designed to support equitable access to care, services, and health information.
Accessibility Standards – Qualified Health Plans (QHP) in the Federally Facilitated Exchanges (FFEs)
Learn about accessibility standards for Qualified Health Plans in federally facilitated exchanges, including requirements for equitable access and compliance.
Antibiotics: Helping decrease inappropriate use
Learn how appropriate antibiotic use helps reduce resistance, improve patient outcomes, and support evidence-based treatment decisions.
Birth Date Edit
Guidelines for birth date edits, including claim validation, denial handling, and resubmission requirements for accurate processing.
Blood Transfusion Services
Review HMSA blood transfusion services billing guidelines, including all‑inclusive payment rates, coding requirements, revenue codes, and billing for blood products and related services.
Change of Ownership, Name, Service Sites, Bankruptcy
Guidelines for reporting changes of ownership, name, service sites, or bankruptcy, including requirements, timelines, and notification processes.
Continuity of Care
Guidelines for continuity of care, including requirements for ongoing treatment, provider transitions, and coverage during care changes.
Continuity of Care - Behavioral Health
Learn about continuity of care for behavioral health, including guidelines for sharing medical information and ensuring uninterrupted treatment for HMSA members.
Coordination of Benefits – HMSA and Another Carrier
Guidelines for coordination of benefits between HMSA and another carrier, including primacy rules, claims filing, and payment responsibilities.