Provider Claims Policies
Welcome to Network Health’s claim policies page. Check this page often for announcements about new and upcoming claims policy changes. If you have questions about the claims policies, please contact us.
Asterisked policies (*) have been updated effective 1/1/2012.
Add-on Codes Policy*
After Hours EM Policy
Age Gender to Diagnosis Code Policy*
Ancillary Policy
Anesthesia Policy*
Assistant Surgeon Policy
Bilateral Policy
Facility & Professional Bundling Policy*
CCI Editing Policy*
Claim Submission Policy*
COB Policy
COB Savings Policy
Corrected Claims Policy
Correcting Provider Overpay Underpay Policy
Global Days Policy*
Modifier 22 Reimbursement Policy
Modifier 52 Reimbursement Policy
Multiple & Endoscopic Policy*
Multiple Imaging Reduction Policy*
Outstanding Overpayment Policy
Preventive Medicine Policy*
Provider Meet & Greet Visits Policy
Pulse Oximetry Policy*
Rebundling Policy*
Robotic Assisted Surgery Policy
Split Surgical Package Policy
Subrogation Policy
Supply Policy*
Team Conferences Policy
Telemedicine Policy*
Timely Filing Policy
Work Comp Submission Policy
Fraud
Health insurance fraud is a criminal offense that can be prosecuted. Any person(s) who willingly and knowingly engages in an activity intended to defraud us by filing a claim or form that contains a false or deceptive statement may be guilty of insurance fraud.
If you commit fraud against us or your employer commits fraud pertaining to you against us, as determined by us, your coverage ends automatically, without notice, as of the date fraud is committed or as of the date otherwise determined by us.
Please Note
Network Health claims policies are intended as a general reference resource and are not intended to address every aspect of a reimbursement situation. Network Health uses reasonable discretion interpreting and applying these policies to services being delivered. The claims policies are not intended to cover all topics and issues related to reimbursement for services rendered to Network Health participants.
The claims policies are the property of Network Health and unauthorized copying, use and distribution are strictly prohibited. Network Health reserves the right to terminate, change, suspend, or discontinue any claims policies at anytime without notice. Changes in these claims policies will be made effective when posted to this site. The claim policies are provided on an "as is" and "as available" basis without warranties of any kind, either express or implied.