Learn about office visit physician services, including covered services, billing guidelines, and documentation requirements for accurate claims processing.

Guidelines for determining the onset date for physical therapy, including criteria, billing requirements, and proper claim submission.

Learn about oral surgery services, including covered procedures, billing guidelines, and documentation requirements for accurate claims processing.

Learn HMSA’s requirements for physician precertification of advanced imaging studies, including MRI, CT, PET, nuclear cardiology, and CCTA scans, plus ordering physician responsibilities and NIA Magellan guidelines.

Understand postoperative visit guidelines for optometrists, including coverage criteria, billing practices, and documentation requirements for compliant care.

Explore the Primary Care Payment Model full code set for 2025, including eligible codes, billing requirements, and payment guidelines for providers.

Learn HMSA’s prior-day hospital admission guidelines, including when admission before surgery is medically appropriate, coverage considerations, examples of qualifying conditions, and claims filing requirements.

Learn how Medicare private contracts work when physicians and practitioners opt out of Medicare, including eligibility requirements, coverage rules, beneficiary impacts, and emergency care provisions.

Learn about HMSA private duty nursing coverage guidelines, including eligibility requirements, covered services by licensed nurses, physician direction criteria, and service exclusions.