The purpose of medical policy is to provide guidelines for determining coverage criteria for specific procedures, equipment and services. The Introduction section of this manual includes information about:
- The approval process
- Research sources
- Definition of medical necessity
- Technology assessment process
- Definition of investigational services
- How we select technologies for policy development
Reimbursement policy documents our payment policy and correct coding for medical and surgical services and supplies. It is used to provide consistent and predictable claims payment through the systematic application of our member contracts, provider agreements and medical policies.
Dental policies have been developed through consideration of government approval status, dental necessity, generally accepted standards of dental practice and review of dental literature. Policy changes are published in The Connection.