Clinical and Payment Policies

Please note that all policies posted on this page apply to members and providers participating in the Meridian Medicaid Plan and may be posted with either a “Meridian” or “Centene” heading.

Clinical Policies

Clinical policies are guidelines used to help administer health plan benefits, either by prior authorization or payment rules. They include (but are not limited to) policies related to evolving medical technologies and procedures, and pharmacy policies. Amendments, modifications, supplements to these policies, and/or additional policies are regularly posted.

For specific services, Meridian may delegate utilization management to a vendor partner. In these circumstances, we may use the delegated vendor’s guidelines to support medical necessity and other coverage determinations. Review the Provider Manual and visit our Prior Authorization page for information about Meridian vendor solution partners.

Pharmacy Policies

Meridian is committed to supplying high-quality, cost-effective drug therapy to all members. Meridian pharmacy policies aid in administering benefits by delineating prior authorization or payment rules. Consult our Pharmacy page for the current Meridian Preferred Drug List (PDL).

Payment Policies

Payment policies are guidelines to assist in administering payment rules based on generally accepted principles of correct coding. They help identify whether healthcare services are correctly coded for reimbursement. Each payment rule is sourced by a generally accepted coding principle, including (but not limited to) claims processing guidelines referenced by: the Centers for Medicare and Medicaid Services (CMS), Publication 100-04, Claims Processing Manual for physicians/non-physician practitioners, the CMS National Correct Coding Initiative policy manual, Current Procedural Technology guidance published by the American Medical Association (AMA) for reporting medical procedures and services, health plan clinical policies and state-specific claims reimbursement guidance.

Review the Provider Manual for additional information about Meridian Billing and Payment policies.