Medical Policy Updates

Notification of Policy Revisions Effective February 11, 2020 (Posted December 2, 2019)

Medical Guidelines Reason for Update
Nonpayment for Serious Adverse Events "Notification" Added final paragraph to Description section. Policy statement revised to read: "Participating providers will not be permitted to receive or retain reimbursement for inpatient or outpatient services related to Never Events. Members will be held harmless for any services related to Never Events." Added "crushing injuries" to list of HACs. Revised coding information for clarity. Claims with no POA indicator populated on an inpatient claim will not be accepted. Link provided for CMS Present on Admission (POA) Exempt List. Notification given 12/2/2019 for effective date 2/11/2020.