Our payers list their requirements, clinical criteria, and other helpful information on their websites.
Links to these resources are below:
Aetna
BCBS
Anthem BCBS Provider Guides - Main [Search by State]
BCBS Michigan Documentation Guidelines
BCBS Illinois Documentation Guidelines
BCBS Texas Documentation Guidelines
BCBS Texas Evaluation & Management Coding + Documentation Guide
BCBS Texas Clinical Practice Guidelines by Diagnosis
BCBS Texas Resources on Coding for Psychological Testing, Neuropsych Testing
Cigna
Evernorth (Cigna Behavioral Health) Administrative Guide (record keeping begins on page 113)
Optum
Other
General CMS Guidelines for E&M Services (insurers base their E&M notes guidance and coding rationale on this)