Explore the FQHC/RHC full code set for 2025, including covered services, coding requirements, billing guidance, and claims submission information.

Explore the FQHC/RHC full code set for 2026, including covered services, coding requirements, billing guidance, and claims submission information.

Learn how HMSA defines health care fraud, examples of fraudulent practices, and how potential fraud is investigated, audited, and referred for further action.

Learn about HMSA’s fraud and abuse investigations, including detection methods, common fraudulent practices, Special Investigations Unit processes, and provider responsibilities.

Overview of the Variable Intensity Review (VIR) program, including tiered utilization management processes that adjust precertification and documentation requirements based on provider compliance.

Learn about ground transportation services, including eligibility, coverage, and guidelines for accessing non-emergency medical transport.

Learn about hair loss (alopecia), including causes, types, and treatment options to manage thinning hair and support healthy hair growth.

Guidelines for health centers and PCPs, including selection, changes, and requirements for managing member care under HMSA plans.

Learn HPH/HMO referral requirements, including when referrals are needed, how to submit them, and services that don’t require referrals for HMSA members.

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