Explains SNF wait-listed status, including when patients remain in acute care, billing rules, payment coverage, and claims filing requirements.

Access a statewide directory of COVID-19 resources and information, including support services, guidance, and tools to help individuals and communities.

The information below is available for providers and their vendors who are interested in submitting HIPAA EDI transactions to HMSA for electronic claims submission, claims status, eligibility and referrals/pre-authorizations.

Learn how to terminate a participating physician agreement with HMSA, including requirements, notice timelines, forms, and next steps for providers.

Understand termination of participation policies, including notice requirements, provider responsibilities, and steps for compliant contract closure.

Explore HMSA guidelines for therapeutic cardiovascular services, including coverage criteria, billing requirements, and provider documentation details.

Learn about the Transparency in Coverage Rule, including price transparency requirements, machine-readable files, and member cost information.

Understand unbundling and fragmentation in claims billing, including improper practices, compliance risks, and guidelines for accurate, ethical reimbursement.

Explore useful healthcare websites, including trusted resources, tools, and links to support providers, members, and informed care decisions.

Learn how to use the drug plan copayments look-up tool to find accurate cost details, coverage information, and plan-specific copayment amounts quickly.