The payment policies listed below is not an exhaustive list of all billing, coding and payment guidelines and policies. To inquire about guidelines not listed here, contact Neighborhood Provider Services at 1-800-963-1001.
Guidelines and policies are updated regularly and are subject to change as State, Federal, CMS, AMA, Neighborhood and other industry standards change. For more information, please refer to Neighborhood’s Provider Manual.
These guidelines are not intended to certify coverage availability. While services or technology may be determined by Neighborhood to be medically necessary, it may not be part of a member’s benefit plan.
All current payment polices are listed below in alphabetical order (all links will open as a PDF document in a new webpage). Previous versions of all temporary and permanent payment policies, as well as, other documents formerly listed on this webpage, are listed on Billing Guidelines and Payment Policies Archive webpage.
A
- Acupuncture Services Payment Policy
- Adult Day Health Services Payment Policy – Updated July 1, 2024
- Anesthesia Services Payment Policy – Updated November 28, 2023
- Assisted Living Payment Policy
B
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C
- Children’s Care Services Payment Policy – Updated July 1, 2024
- Chiropractic Services Payment Policy
- Claim Adjustment Grid Process
- Clinical Trials Payment Policy
- Complementary and Alternative Medicine (CAM) Services Payment Policy
D
- Diabetes Prevention Program Payment Policy – Updated September 18, 2024
- Drug Testing Payment Policy
- Durable Medical Equipment (DME) Payment Policy – Updated September 18, 2024
E
F
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G
- Gene Therapy Billing Policy – Updated March 23, 2023
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H
- Hearing Aid Payment Policy – New! July 1, 2024
- Home Health Agency Services Payment Policy – Updated September 18, 2024
- Home Infusions Payment Policy – Updated November 28, 2023
- Hospice Services Payment Policy – Updated March 11, 2024
- Hospital Readmission Payment Policy – Updated November 28, 2023
I
- Immunization and Vaccine Payment Policy – Updated March 1, 2024
- In Lieu of Services Payment Policy – Updated March 11, 2024
- Inpatient Hospital Payment Policy
- Interpreter Services Payment Policy – Updated November 28, 2023
- Intraoperative Neurophysiological Monitoring and Testing Services Payment Policy – New! Effective October 1, 2024
J
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K
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L
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M
- Mammography Screening Payment Policy
- Medically Administered Medications Payment Policy – Updated September 5, 2023
- Modifier Payment Policy – Updated September 1, 2024
- Multiple Procedure Payment Policy
N
- Newborn Payment Policy – New! July 1, 2024
- Non-Covered Services Payment Policy – Updated September 18, 2024
O
- Observation Facility Payment Policy – New! July 1, 2024
- Obstetrical Services Payment Policy – Updated November 28, 2023
- Oral Surgery Payment Policy – Updated September 18, 2024
- Out of Network Payment Policy
P
- Pharmaceuticals NDC Billing Requirements Policy – Updated March 29, 2023
- Physical and Occupational Rehabilitation Services Payment Policy – Updated effective June 1, 2024
- Physician Services Payment Policy – Updated July 1, 2024
- Provider Preventable Condition Payment Policy – Updated November 28, 2023
Q
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R
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S
- Skilled Nursing Facility Payment Policy – Updated March 11, 2024
- Speech Therapy Services Payment Policy – Updated effective June 1, 2024
T
- Telemedicine/Telephone Services Payment Policy – Updated July 1, 2024
- Transplant Services Payment Policy – Updated November 28, 2023
U
- Unlisted/Unspecified Procedure Codes Billing Guidelines – Updated November 28, 2023
V
- Vision Care Services Payment Policy – Updated July 1, 2024
- Vitamin D Testing Payment Policy – New! Effective June 1, 2024
W
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X
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Y
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Z
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