Billing & payment news
09/15/2025: September 2025 billing policy updates
We publish billing policies to offer transparency and help you bill claims more accurately to reduce delays in processing claims, as well as avoid rebilling and additional requests for information.
September 12, 2025
9/4/2025: Reprocessing claims incorrectly rejected for Medicaid edit 1462
We recently experienced a brief issue with some Medicaid claims being front-end rejected for “Missing/Invalid NDC” when they shouldn’t.
September 4, 2025
August 2025 billing policy updates
The following billing policies were recently published to or updated in our Provider Manual’s Billing Policies page.
August 8, 2025
Fee schedule change for non-physician Medicaid behavioral health services
Effective Oct. 1, 2025, our standard Medicaid reimbursement for all non-physician behavioral health providers (i.e., LP, LMSW, LPC, LLP, LMFT) will align with industry standards and be based on MDHHS’ Non-Physician Behavioral Health Fee Schedule, rather than the Practitioner/Medical Clinic Fee Schedule currently used.
July 10, 2025
Billing policy reminders
We’re reminding our provider network about several billing policies and requirements as we’ll soon implement clinical edits in alignment with the outlined information.
July 7, 2025
July 2025 billing policy updates
The following billing policies were recently published to or updated in our Provider Manual’s Billing Policies page.
July 2, 2025
Medicare therapy cap changes effective Jan 1 2025
Starting Jan. 1, 2025, we're changing our Medicare therapy caps for physical, occupational and speech therapies (PT/OT/ST) to align with recent CMS guideline updates.
June 29, 2025
New and updated billing policies
We’ve posted several new and updated billing policies, which align to industry standards, to the Provider Manual.
June 29, 2025
2025 commercial fee schedules are available online
2025 commercial fee schedules are available online
June 29, 2025
Understanding disallow code OX6
It’s important to us that you understand the way your claims are handled – including what the various codes that may appear on your remittance advice mean. One claim adjustment code we get a lot of questions about is OX6.
June 29, 2025
New and updated billing policies are now available
We’ve posted several new and updated billing policies, which align to industry standards, to the Provider Manual.
June 29, 2025
Resolving some vaccine codes denying incorrectly
We're correcting two issues with vaccine claims denying when they shouldn't.
June 29, 2025