Payer Guides — UHC, Aetna, Cigna, Humana, BCBS, Medicare 2026
Payer-specific guides for prior authorization, eligibility verification, and CPT codes. Covering UnitedHealthcare, Aetna, Cigna, Humana, BCBS, and Medicare.
26 articles
QuickIntell's payer guides give revenue cycle leaders, authorization teams, front-desk eligibility staff, and specialty coders a working reference for nine high-volume payer families: UnitedHealthcare, Aetna, Cigna, Humana, BCBS, Anthem, Medicare, Medicaid, and Tricare. The hub also covers specialty CPT workflows for urgent care, podiatry, dermatology, emergency medicine, cardiology, orthopedics, OB/GYN, gastroenterology, neurology, and ophthalmology, so teams can connect payer rules to the codes that actually trigger edits, prior authorization, and denial risk.
The source corpus behind these guides combines CMS manuals and transmittals, AMA CPT code-set guidance, X12 eligibility and claim-status standards, and public payer portal policies. Every guide is authored by the QuickIntell editorial team, medically reviewed by Dr. David Rawaf, MBBS (Imperial College London), and operationally checked by credentialed revenue cycle reviewers with CRCR, CPC, and CCS experience. Payer-guide pages follow a 365-day staleness SLA and are re-reviewed sooner when a payer policy, CMS rule, X12 workflow, or CPT requirement materially changes.
Each guide maps to a QuickIntell product path: prior authorization guides connect to QuickAuth for packet validation, submission, tracking, renewal, and appeal workflows; eligibility guides connect to eligibility automation for 270/271 checks, payer fallback, and pre-visit coverage flags; and specialty CPT guides connect to QuickCode for code selection, scrub logic, modifier support, and first-pass acceptance.
For the full review process, reviewer credentials, sourcing rules, and correction policy, see our editorial standards. To request a topic, flag a factual correction, or ask for deeper coverage on a specific code set or payer, reach the editorial team through the QuickIntell contact page.
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Featured
Editor's picksUnitedHealthcare Prior Authorization Guide 2026: Requirements, Process, and Automation
UnitedHealthcare prior authorization is required for most inpatient admissions, advanced imaging, specialty drugs, genetic testing, behavioral health resid...
Aetna Prior Authorization Guide 2026: Operational Workflow, Documents, and Appeals
Aetna prior authorization is an operational workflow for confirming whether a planned service, drug, site of care, or admission needs Aetna precertificatio...
ReadPayer GuideCigna Prior Authorization Guide 2026: Operational Workflow, Documents, and Appeals
Cigna prior authorization starts with plan-level verification: confirm the member's Cigna product, check whether the planned service needs authorization, i...
ReadEligibility Verification
Aetna Eligibility Verification Guide 2026: How to Check Benefits and Coverage in Real Time
· Reviewed by Dr. David Rawaf, MBBS
Aetna covers approximately 34 million medical members across commercial, Medicare Advantage, and Medicaid managed care plans. For healthcare organizations ...
Cigna Eligibility Verification Guide 2026: Checking Benefits and Coverage Accurately
· Reviewed by Dr. David Rawaf, MBBS
Cigna Healthcare -- now operating under The Cigna Group alongside Evernorth Health Services -- covers approximately 17 million medical members across emplo...
UnitedHealthcare Eligibility Verification Guide 2026: Real-Time Benefits Checking
· Reviewed by Dr. David Rawaf, MBBS
UnitedHealthcare is the largest commercial health insurer in the United States, covering more than 50 million members across employer-sponsored, individual...
Humana Eligibility Verification Guide
· Reviewed by Dr. David Rawaf, MBBS
Humana covers approximately 17 million medical members across a product portfolio that skews heavily toward Medicare Advantage. In fact, Humana is one of t...
Blue Cross Blue Shield Eligibility Verification Guide
· Reviewed by Dr. David Rawaf, MBBS
Blue Cross Blue Shield is not a single insurance company. It is a federation of 34 independent, locally operated companies -- called licensees or plans -- ...
CPT Codes by Specialty
Urgent Care CPT Codes: A Complete Reference for 2026
· Reviewed by Dr. David Rawaf, MBBS
Urgent care centers operate in a coding environment unlike any other specialty. A single provider might treat a straightforward sore throat, repair a compl...
Podiatry CPT Codes: Complete Billing Reference for Foot and Ankle Practices
· Reviewed by Dr. David Rawaf, MBBS
Podiatry occupies a unique position in healthcare billing. It is one of the few specialties where a significant portion of services — routine foot care — i...
Dermatology CPT Codes: Billing Reference for Skin, Lesion, and Procedure Coding
· Reviewed by Dr. David Rawaf, MBBS
Dermatology is one of the most procedure-intensive specialties in medicine. A single dermatologist performing a full clinic day might conduct 30-40 encount...
Emergency Medicine CPT Codes: Complete Coding Reference for ED Billing
· Reviewed by Dr. David Rawaf, MBBS
Emergency medicine is the only specialty where every patient is unscheduled, every diagnosis is unknown at presentation, and the clinical complexity can ra...
Cardiology CPT Codes: Complete 2026 Reference Guide
· Reviewed by Dr. David Rawaf, MBBS
Cardiology generates more CPT code diversity than nearly any other medical specialty. A single cardiologist may perform an office evaluation, interpret an ...
Orthopedic CPT Codes: Surgery, Fracture & Joint Procedure Reference
· Reviewed by Dr. David Rawaf, MBBS
Orthopedic surgery generates some of the highest-dollar claims in medicine, and the coding precision required to capture that revenue is equally high. A si...
OB-GYN CPT Codes: Pregnancy, Delivery & GYN Procedure Reference
· Reviewed by Dr. David Rawaf, MBBS
OB-GYN coding is unlike any other specialty because it operates under two fundamentally different billing models simultaneously. Obstetric care uses a glob...
Gastroenterology CPT Codes: Endoscopy & GI Procedure Reference
· Reviewed by Dr. David Rawaf, MBBS
Gastroenterology is one of the most procedure-intensive specialties in medicine, and the coding decisions made on every endoscopy case directly determine w...
Neurology CPT Codes: EEG, EMG & Neurological Testing Reference
· Reviewed by Dr. David Rawaf, MBBS
Neurology is a diagnostic-heavy specialty where the majority of revenue comes from two sources: complex evaluation and management encounters and specialize...
Ophthalmology CPT Codes: Eye Surgery & Procedure Reference
· Reviewed by Dr. David Rawaf, MBBS
Ophthalmology generates an unusually high ratio of procedure revenue to E/M revenue compared to most medical specialties. A busy comprehensive ophthalmolog...
Government & Special Payers
Medicare Eligibility Verification Guide 2026: Parts A, B, C, and D Coverage Checking
· Reviewed by Dr. David Rawaf, MBBS
Medicare covers more than 67 million Americans, making it the single largest payer in the U.S. healthcare system. For most healthcare organizations -- part...
Medicare Advantage Billing: How It Differs from Original Medicare
· Reviewed by Dr. David Rawaf, MBBS
Medicare Advantage now covers more than 54% of all Medicare beneficiaries -- over 35 million Americans. That percentage continues to climb, and for most he...
Medicaid Prior Authorization Guide (Top 10 States)
· Reviewed by Dr. David Rawaf, MBBS
Medicaid covers more than 90 million Americans, making it the largest health insurance program in the United States by enrollment. Unlike Medicare or comme...
Tricare Prior Authorization & Billing Guide
· Reviewed by Dr. David Rawaf, MBBS
Tricare covers approximately 9.6 million beneficiaries -- active-duty service members, retirees, their families, and survivors. For healthcare organization...
Medicaid Eligibility Verification Guide
· Reviewed by Dr. David Rawaf, MBBS
Medicaid eligibility verification is fundamentally different from verifying commercial insurance or even Medicare. With commercial payers, eligibility is r...
Frequently Asked Questions
What is a payer guide?
A payer guide is a reference document explaining how a specific health insurer handles prior authorization, eligibility verification, claim submission, appeals, and timely filing. It combines the payer's published policies (from portals like UHCprovider.com, CignaforHCP.com, and Availity) with the operational details revenue cycle teams need to avoid denials.
How often are QuickIntell payer guides updated?
Every QuickIntell payer guide carries a last_reviewed date and is re-reviewed at least annually, or sooner when a payer publishes a material policy change (new PA list, timely filing change, or appeal-process update). The registry-backed payer pages in /payers are refreshed on the same cadence.
Who reviews QuickIntell payer guides?
Every payer guide is reviewed by the QuickIntell RCM editorial team and medically reviewed by Dr. David Rawaf, MBBS (Imperial College London). Credentialed CRCR / CPC / CCS reviewers with 5+ years of revenue cycle experience attest to the accuracy of payer-specific workflow, timeline, and denial-reason content.
Which payers does QuickIntell automate prior auth for?
QuickIntell prior authorization workflows support high-volume commercial, Medicare, Medicaid, and specialty-payer paths, including UnitedHealthcare, Aetna, Cigna, Humana, BCBS, Anthem, Medicaid, Medicare Advantage, and Tricare guide coverage. QuickAuth uses the payer-specific rules in these guides to detect requirements, prepare packets, track status, and route exceptions through the right portal, clearinghouse, fax, or fallback channel.
How are CPT-code guides kept current with AMA releases?
CPT-code guides are re-reviewed against the annual AMA CPT release cycle, CMS and NCCI updates, specialty-society guidance, and payer policy bulletins. When a new code, descriptor, modifier rule, edit, or payer requirement materially changes a guide, QuickIntell updates the article and refreshes its last-reviewed date instead of waiting for the normal annual staleness review.
Can I cite a QuickIntell payer guide in our payer-meeting brief?
Yes. QuickIntell payer guides are designed to be citation-friendly for payer-meeting briefs, internal SOPs, denial-prevention playbooks, and revenue cycle training. Cite the guide title, QuickIntell as publisher, the visible last-reviewed date, and the source URL so reviewers can trace the payer policy summary back to the reviewer-stamped original.
Medically reviewed by
Dr. David Laith Rawaf, MBBS
Medical Reviewer · Imperial College London · WHO · Royal College of Surgeons
Surgeon and global health-tech advisor. Reviews QuickIntell guides for clinical accuracy and ensures operational billing content is not mistaken for medical advice.
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