Institutional / UB Manual and Bulletins


Institutional/UB Manuals

Institutional Provider Manual (Effective 10.25.21)

Tribal Provider Manual (10.25.21)

Provider Medicaid and State Health Care Benefit Plan (10.19.21)

APR-DRG Navigant Presentation

DRG Edits and EOBs

DRGs Requiring Prior Authorization

Fee Schedule - Access this page for Standard Fee Schedule information, the Procedure Code Search, and the Genetic Testing Fee Schedule.

OPPS Fee Schedule - Access this page specifically for the APC-based Fee Schedules for the Outpatient Prospective Payment System (OPPS).

Important Dental Prior Authorizatoin Changes

LOC Diagnosis and Procedure Codes

Medicaid Pregnancy and Post-Partum Care Billing Infographic

Nursing Home Swing Bed Billing and PASRR Requirements

Optum Bulletin - Dental iExchange Registration and Trainings

PASRR Manual

PASRR Level 2 Diagnosis List

TPL Priority Diagnosis List - This is a list of diagnosis codes that must be billed with external cause code(s).  This list includes diagnoses for burns, corrosion, abrasions, contusions, hematomas, crushing injuries, fractures, head injuries, other injuries, spinal injuries, wounds, and lacerations.

Note: To search for specific information within the PDF document, select Ctrl F on your keyboard and type your keyword in the find box.