Reimbursement/Payment Policy policy updates
Track new and updated Reimbursement/Payment Policy policies impacting reimbursement and clinical operations.
| Policy | Payer | Type | Specialty | Change | Effective |
|---|---|---|---|---|---|
| Payment Policy: Skilled Nursing Facility Leveling | Arizona Complete Health | Reimbursement | — | Modified | Aug 1, 2026 |
| Payment Policy: Sepsis Diagnosis | Arizona Complete Health | Reimbursement | — | Modified | Jul 1, 2026 |
| Severe Malnutrition Payment Policy | Arizona Complete Health | Reimbursement | — | Modified | Jan 1, 2026 |
| Acute - Long Term Care Drug List (behavioral health and stimulants) | Arizona Complete Health | Reimbursement | — | Modified | Apr 1, 2025 |
| Concert Genetic Testing: Toxicology and Pharmacogenetics (Version B) | Arizona Complete Health | Reimbursement | — | Modified | Aug 24, 2024 |
| Optum Comprehensive Payment Integrity (CPI) | Arizona Complete Health | Reimbursement | — | Modified | Apr 1, 2023 |
| Clinical Validation of Modifier 25 | Arizona Complete Health | Reimbursement | — | Modified | Jan 1, 2023 |
| Unbundling Adjustments on Clean Claim Reviews | Arizona Complete Health | Reimbursement | — | Modified | Sep 1, 2022 |
| Cost-to-Charge Adjustments on Clean Claim Reviews | Arizona Complete Health | Reimbursement | — | Modified | Jun 14, 2022 |
| Payment Policy: Leveling of Emergency Room Services | Arizona Complete Health | Reimbursement | — | Modified | Sep 1, 2021 |
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.
OpenPayer by Trek Health — Policy intelligence for billing and revenue cycle teams.
Coverage data is sourced from publicly available payer medical policy documents and updated as payers publish revisions. Read more about where our data comes from. Always consult the primary payer source for clinical decision-making.