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 October 1, 2022
- Anesthesia Services Payment Policy – New! Effective January 1, 2023
- Assisted Living Payment Policy
B
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C
- Children’s Care Services Payment Policy – Updated October 1, 2022
- Chiropractic Services Payment Policy – New! Effective January 1, 2023
- Claim Adjustment Grid Process
- Clinical Trials Payment Policy – New! Effective November 15, 2022
- Complementary and Alternative Medicine (CAM) Services Payment Policy – New! Effective January 1, 2023
- COVID-19 Vaccine Payment Policy (Replaced with Immunization and Vaccine Payment Policy, effective 11/12/2021)
D
- Diabetes Prevention Program Payment Policy – Updated October 1, 2022
- Drug Testing Payment Policy – New! Effective January 1, 2023
- Durable Medical Equipment (DME) Payment Policy – New! Effective January 1, 2023
E
- Extended Family Planning (EFP) Services Payment Policy – Updated October 1, 2022
F
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G
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H
- Home Health Care Services Payment Policy
- Hospice Services Payment Policy – New! Effective January 1, 2023
- Hospital Readmission Payment Policy – Updated October 1, 2022
I
- Immunization and Vaccine Payment Policy – New! Effective January 1, 2023
- In Lieu of Services Payment Policy – New! Effective January 1, 2023
J
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K
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L
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M
- Mammography Screening Payment Policy – New! Effective January 1, 2023
- Modifier Payment Policy
- Multiple Procedures Payment Policy – Updated October 1, 2022
N
- Non-Covered Services Payment Policy – New! Effective March 29, 2023
O
- Obstetrical Services Payment Policy – New! Effective January 1, 2023
- Oral Surgery Payment Policy – Updated October 1, 2022
- Out of Network Payment Policy – Updated May 2, 2022
P
Pharmaceutical policies and guidance are published on Neighborhood’s Pharmacy webpage.
- Physical and Occupational Rehabilitation Services Payment Policy
- Physician Services Payment Policy – Updated May 2, 2022
- Provider Preventable Condition Policy – Updated October 1, 2022
Q
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R
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S
- Skilled Nursing Facility Payment Policy – Updated October 1, 2022
- Speech Therapy Services Payment Policy – New! Updated December 1, 2022
T
- Temporary COVID-19 Testing and Treatment Services Policy
- Telemedicine/Telephone Services Payment Policy – New! Updated January 27, 2023 | Click here for a summary of changes
- Transplant Services Payment Policy – New! Effective January 1, 2023
U
- Unlisted/Unspecified Procedure Codes Billing Guidelines – Updated October 1, 2022
V
- Vision Care Services Payment Policy – Updated March 29, 2023
W
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X
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Y
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Z
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