Look up Medical and Payment Policies
Search, view, and print our current medical coverage and payment policies. Please note this is not a complete listing. We update policies on a regular basis and they are subject to change.
The policies below exclude Federal Employee Program® (FEP) products. For FEP policies, please call (401) 272-5670.
Please note: Policies are subject to change. If you can't find a policy for a specific service, please always refer to the following policies:
Frequently Used Policies
- Genetic Testing Services
- Prior Authorization of Cardiology and Radiology Services
- Prior Authorization via Web-Based Tool for Durable Medical Equipment (DME)
- Prior Authorization of Drugs
- Prior Authorization via Web-Based Tool for Procedures
- Telemedicine/Telephone Services for Medicare Advantage Plans during the Public Health Emergency (PHE) - Effective 8/3/2022
- TEMPORARY Cost Share Waiver for Treatment of Confirmed Cases of Covid-19
- Prior Authorization of Spinal Procedures
- COVID-19 Diagnostic Testing After PHE End Date
- Non-Reimbursable Health Service Code Policy (2024)
- Prior Authorization via Web-Based Tool for Procedures, Effective 1/1/2025
- Prior Authorization via Web-Based Tool for Durable Medical Equipment (DME), effective 3/1/2025
- Prior Authorization via Web-Based Tool for Procedures, Effective 2/1/2025
- Prior Authorization via Web-Based Tool for Procedures, Effective 3/1/2025
- Genetic Testing Services - Effective 3/1/2025