Reimbursement Policies
We want to assist physicians, facilities and other providers in accurate claims submissions and to outline the basis for reimbursement if the service is covered by an enrollee’s benefit plan.
Reimbursement policy overview
Keep in mind that determination of coverage under an enrollee's benefit plan does not necessarily ensure reimbursement. These policies may be superseded by state, federal or CMS requirements. Providers and facilities are required to use industry standard codes for claim submissions.Services should be billed with appropriate CPT® codes, HCPCS codes and/or revenue codes. The billed code(s) should be fully supported in the medical record and/or office notes. Industry practices are constantly changing, and we reserve the right to review and revise policies periodically.
Policies
Interested in becoming a provider in the Wellpoint District of Columbia network?
We look forward to working with you to provide quality service for our enrollees.