The federal government will end the COVID-19 emergency declarations on May 11, 2023. This means starting May 12, 2023, standard health plan provisions will apply with cost shares as applicable for COVID-19 testing, related services and vaccine administration. Read more
Billing – Claim Submission
General
Policy Number: GP-X-038
Last Updated: May 24, 2022
The only exception to a provider’s requirement to submit claims is HIPAA rule 164.522(a)(1)(vi). If a member requests that a provider restrict disclosure of Protected Health Information (PHI) to the health plan AND pays the provider in full, the request must be honored. The request is only applicable for those services/items specifically directed by the member and paid in full.
This does not apply to PHI required to be disclosed due to federal or state mandates and laws. For more information see the following: Federal Register January 25, 2013 – Final Rule.