Medicare Advantage Provider Manual

Size: px
Start display at page:

Download "Medicare Advantage Provider Manual"

Transcription

1 Medicare Advantage Provider Manual

2

3 Table of Contents WELCOME... 3 INTRODUCTION... 3 SECTION 1: HEALTHSPAN MEDICAL CARE PROGRAM HISTORY HealthSpan Mission Statement HealthSpan Values ORGANIZATIONAL STRUCTURE HealthSpan Physicians, LLC HealthSpan, Inc HEALTHSPAN MEDICARE ADVANTAGE SERVICE AREA HealthSpan Service Area Map

4 Welcome It is our pleasure to welcome you as a Plan Provider with HealthSpan Medicare Advantage, offered in 31 counties throughout the State of Ohio by HealthSpan Integrated Care, hereafter identified as HealthSpan. As a valued Plan Provider, we want this business relationship to work well for you, your medical support staff, and HealthSpan Members. The HealthSpan Network Development and Performance (Provider Relations) Department is committed to providing support to you and your staff. This includes responding to your operational inquiries and providing education regarding new products and plans. If, at any time, you have a question or concern about the information outlined in this Manual, you can reach our Provider Relations Department by calling , option 1. Introduction This Provider Manual ( Manual ) is referenced in your Agreement ( Agreement ) with a HealthSpan entity. The information in this Manual is proprietary and may not be used, circulated, reproduced, copied or disclosed in any manner whatsoever, except as specified in your Agreement, or with prior written permission from HealthSpan. The HealthSpan is posted on the Providers website at healthspan.org/providers/north-coast. Updates, changes and additions to the information contained herein are posted on this website and made part of this Manual as of the date posted thereon, unless otherwise required by your Agreement or applicable Law. If there is a conflict between this Manual and your Agreement, the terms of your Agreement will control. All defined terms in Section 11 of this HealthSpan Medicare Advantage Provider Manual are capitalized throughout this Manual. Capitalized terms that are used in this Manual, but not defined, will have the meanings given to them in your Agreement. Provider Support For your convenience, HealthSpan has established a phone system that allows Plan Providers to call one phone number to address most issues or questions regarding HealthSpan Plan protocols or Members. Representatives are available to answer your questions Monday through Thursday, from 8:15 a.m. to 5 p.m. and on Fridays from 9 a.m. to 5 p.m. Once you dial , you will be prompted to select one of the following options: 3

5 Option 1: This option will connect you with a representative in the Customer Relations Department who can assist with any of the following inquiries: Member Eligibility and Covered Benefits verification. Claims payment inquiries (that is, to check on the status of Claim payment, an over or under claim payment, a denial or partial denial of Services, or Coordination of Benefits). Claims submission questions. Obtain current Plan Provider directories. Electronic Data Interchange Clearinghouse information. Option 2: Option 3: If a HealthSpan Member needs to be admitted to a hospital, select option 2. Option 2 will connect you with a representative in the HealthSpan Repatriation Department. To initiate an urgent or emergent request for Services requiring Referral or Precertification, select option 3. Option 3 will connect you with a representative in the HealthSpan Referrals Management and Clinical Review Department ( [toll-free]). To initiate a new Referral request for routine Services requiring Authorization, fax your request to the HealthSpan Referrals Management and Clinical Review Department at (toll-free). For the following inquiries, contact your designated Provider Relations Department in Cleveland or Cincinnati: Add or delete a Practitioner in the practice. Confirm or change the open or closed status of a Practitioner s practice with HealthSpan. Provide demographic updates. Agreement questions. If a Member has a question about Covered Benefits, desires to change his/her Primary Care Physician, would like to file a compliment or Complaint, or appeal an Adverse Determination, refer the Member to the HealthSpan Customer Relations Department, 8 a.m. 8 p.m. daily, The hearing/speech impaired may call 711 (toll free TTY). 4

6 HealthSpan 1.1 History HealthSpan Partners is a non-religious, supporting organization of Mercy Health, formerly Catholic Health Partners. Mercy Health is the largest health system in Ohio and operates more than 250 health facilities, including 24 hospitals, 15 senior living communities, five hospice programs, eight home health agencies and a health insurance plan HealthSpan Mission Statement HealthSpan delivers compassionate, high-quality, affordable health care to improve the health of our communities with emphasis on people who are poor and underserved HealthSpan Values HealthSpan demonstrates behaviors reflecting our core values of compassion, excellence, human dignity, justice, sacredness of life and service. 1.2 Organizational Structure HealthSpan Physicians, LLC Health Span Physicians, LLC, is a medical group practice that delivers integrated care through its multispecialty medical group that serves Members in Northeast Ohio Working in partnership with HealthSpan Physicians, LLC, HealthSpan Integrated Care is a non-profit organization that offers Traditional Health Maintenance Organization, Point-of-Service and Medicare Plans in northeastern Ohio HealthSpan, Inc. HealthSpan, Inc. offers an array of self-insured, individual, commercial, Medicare and Medicaid Plans throughout the State of Ohio. 1.3 HealthSpan Medicare Advantage Service Area Following is a map of the HealthSpan Medicare Advantage Service Area. To find a Plan participating Provider, including ancillary Providers, access the Provider Lookup feature online at healthspan.org/findaprovider. Enter your zip 5

7 code, select a search radius and choose the way you prefer to search. If you prefer a paper directory, contact the HealthSpan Customer Relations Department at , option HealthSpan Service Area Map See the following page. 6

8 7

Provider Manual + HEALTHSPAN

Provider Manual + HEALTHSPAN Provider Manual + HEALTHSPAN Section 1: HealthSpan Provider Manual Medical Care Program For Fully Insured + HEALTHSPAN Table of Contents WELCOME...4 INTRODUCTION...4 SECTION 1: HEALTHSPAN MEDICAL CARE

More information

Member Rights, Complaints and Appeals/Grievances 5.0

Member Rights, Complaints and Appeals/Grievances 5.0 Member Rights, Complaints and Appeals/Grievances 5.0 5.1 Referring Members for Assistance The Member Services Department has representatives to assist with calls for: General verification of member eligibility

More information

Self-Funded Provider Manual Introduction Section 1 Kaiser Permanente Medical Care Program Section 2 Key Contacts

Self-Funded Provider Manual Introduction Section 1 Kaiser Permanente Medical Care Program Section 2 Key Contacts Self-Funded Provider Manual Introduction Section 1 Medical Care Program Section 2 Key Contacts Self-Funded Provider Manual 1 Welcome to the Self-Funded Program It is our pleasure to welcome you as a Provider

More information

Patient Billing. Questions/ Answers. Assistance Programs

Patient Billing. Questions/ Answers. Assistance Programs Patient Billing Questions/ Answers Assistance Programs Table of Contents Patient billing: an introduction... 1 Patient financial responsibilities... 2 Our promise to you... 3 Frequently asked questions...

More information

Stay Healthy. In the Know. Screenings you and your family need. Protect yourself against health care fraud. www.aultcare.com

Stay Healthy. In the Know. Screenings you and your family need. Protect yourself against health care fraud. www.aultcare.com good health FALL 2015 YOUR FAST TRACK TO LIVING WELL Stay Healthy Screenings you and your family need In the Know Protect yourself against health care fraud www.aultcare.com TELL US HOW WE ARE DOING Whether

More information

Creating a new model of care for a healthier Ohio

Creating a new model of care for a healthier Ohio Creating a new model of care for a healthier Ohio A Collaborative Vision of Introducing Health Innovations Ohio In the true spirit of collaboration, four of Ohio s most highly regarded health systems are

More information

Exhibit 4. Provider Network

Exhibit 4. Provider Network Exhibit 4 Provider Network Provider Contract Requirements ICS must develop, implement, and maintain a comprehensive provider network that assures access to primary and specialty health related care that

More information

Insurance Intake Form, Authorization and Assignment of Benefits

Insurance Intake Form, Authorization and Assignment of Benefits Recipient Information Insurance Intake Form, Authorization and Assignment of Benefits Return completed and signed form with copies of insurance card(s), front and back, to: Fax: (303) 200-5441 E-mail:

More information

Neighborhood Health Partnership

Neighborhood Health Partnership Neighborhood Health Partnership Answers to Frequently Asked Questions Q. Whom do I call for assistance or if I need information in another language? A. Call Customer Service at the phone number on your

More information

Dental Orientation. Molina Healthcare

Dental Orientation. Molina Healthcare Dental Orientation Molina Healthcare Scion Provider Web Portal The Scion Electronic Outreach Team is calling all providers offices to provide information and help with registration. Some offices may receive

More information

Medicare Advantage Provider Manual

Medicare Advantage Provider Manual Medicare Advantage Provider Manual Table of Contents SECTION 4: UTILIZATION MANAGEMENT... 4 4.1 DECISION MAKING FOR MEDICAL SERVICE REQUESTS... 4 4.2 CONCURRENT REVIEW PROCESS... 4 4.3 MEDICAL APPROPRIATENESS

More information

Tribute Health Plan of Arkansas (HMO SNP), a Superior Select product.

Tribute Health Plan of Arkansas (HMO SNP), a Superior Select product. Tribute Health Plan of Arkansas (HMO SNP), a Superior Select product. Tribute Health Plan of Arkansas HMO SNP is a Health plan with a Medicare contract. Enrollment in Tribute Health Plan of Arkansas HMO

More information

Complete the enrollment form on the reverse side to join Onyx 360 today.

Complete the enrollment form on the reverse side to join Onyx 360 today. Complete the enrollment form on the reverse side to join Onyx 360 today. Oncology Nurse Advocates are available Monday through Friday, from 9 am to 8 pm Eastern Standard Time at 1-855-ONYX-360 (1-855-669-9360)

More information

A Community of Caring

A Community of Caring 419-289-1585 www.brethrencarevillage.org 2000 Center Street Ashland, Ohio, 44805 A Community of Caring Three minutes from Samaritan Hospital Twenty minutes to Mansfield Midway between Cleveland and Columbus

More information

Children s Long Term Support (CLTS) Waiver Third Party Administration (TPA) Claims Processing

Children s Long Term Support (CLTS) Waiver Third Party Administration (TPA) Claims Processing Children s Long Term Support (CLTS) Waiver Third Party Administration (TPA) Claims Processing Wisconsin Department of Health Services Division of Long Term Care Bureau of Long-Term Support 1 Third Party

More information

Managed Care Organization and Provider Forum Region 3 June 24, 2013

Managed Care Organization and Provider Forum Region 3 June 24, 2013 Managed Care Organization and Provider Forum Region 3 June 24, 2013 Humana Headquartered in Kentucky Fortune 100 company Leading national healthcare company 12 million medical members 8 million specialty

More information

4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21. Welcome to Avera Health Plans

4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21. Welcome to Avera Health Plans Member Guide 1 1 Welcome to Avera Health Plans 2 In Your Neighborhood Benefits of Health Insurance Understanding Health Insurance Terms 3 Get on Track With Your Insurance Coverage 4-5 Member Resources

More information

Connecticut Medical Assistance Program Workshop for Professional Claim Billing Providers

Connecticut Medical Assistance Program Workshop for Professional Claim Billing Providers Connecticut Medical Assistance Program Workshop for Professional Claim Billing Providers Presented by The Department of Social Services & HP Enterprise Services HP Restricted 2009 Hewlett-Packard Development

More information

2016 Provider Directory. Commercial Unity Prime Network

2016 Provider Directory. Commercial Unity Prime Network 2016 Provider Directory Commercial Unity Prime Network TM IMPORTANT CONTACT INFORMATION Read the instructions for using this network and then complete this page after you have selected Primary Care Physicians

More information

The Health and Benefit Trust Fund of the International Union of Operating Engineers Local Union No. 94-94A-94B, AFL-CIO. Notice of Privacy Practices

The Health and Benefit Trust Fund of the International Union of Operating Engineers Local Union No. 94-94A-94B, AFL-CIO. Notice of Privacy Practices The Health and Benefit Trust Fund of the International Union of Operating Section 1: Purpose of This Notice Notice of Privacy Practices Effective as of September 23, 2013 THIS NOTICE DESCRIBES HOW MEDICAL

More information

Non-Emergency Medical Transportation (NEMT) FAQ

Non-Emergency Medical Transportation (NEMT) FAQ Non-Emergency Medical Transportation (NEMT) Frequently Asked Questions What are NEMT services? The NEMT services are for members with full Medicaid benefits, who need travel reimbursement or a ride to

More information

If your legal representative signs the form for you, we need documentation of a power of attorney, guardianship, or conservatorship.

If your legal representative signs the form for you, we need documentation of a power of attorney, guardianship, or conservatorship. How to File a Claim Getting Started As soon as you need or think you may need formal (paid) long-term care (LTC) services, contact us and let us know about your condition. Call Customer Service tollfree

More information

Frequently Asked Billing Questions

Frequently Asked Billing Questions Frequently Asked Billing Questions How will I be billed? Mayo Clinic Health System will send you a billing statement with your charges. Provider charges for clinic and hospital services will be billed

More information

ATTENTION PRACTICE MANAGERS

ATTENTION PRACTICE MANAGERS Volume VI; June 2013 ATTENTION PRACTICE MANAGERS MUST USE Easier to Read Asterisks detailing required information New telephonic team working to give you timely status updates AZPCP Prior Authorization

More information

Evidence of Coverage

Evidence of Coverage January 1 December 31, 2016 Evidence of Coverage Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of Kaiser Permanente Senior Advantage Medicare Medicaid (HMO SNP)

More information

Social Care, Health and Housing Substance Misuse Team. How can we help? www.carmarthenshire.gov.uk/socialcare

Social Care, Health and Housing Substance Misuse Team. How can we help? www.carmarthenshire.gov.uk/socialcare Social Care, Health and Housing Substance Misuse Team How can we help? www.carmarthenshire.gov.uk/socialcare If you require this information in large print, Braille or on Audio please telephone 01267 228703

More information

PHYSICIAN PRE-APPLICATION CENTRAL FLORIDA PHYSICIANS ALLIANCE, INC. A Physician Owned Independent Practice Association Serving Central Florida

PHYSICIAN PRE-APPLICATION CENTRAL FLORIDA PHYSICIANS ALLIANCE, INC. A Physician Owned Independent Practice Association Serving Central Florida Place you r m essag e h ere. Fo r m axim um i mpact, use two or t hre e se ntenc es. PHYSICIAN PRE-APPLICATION CENTRAL FLORIDA PHYSICIANS ALLIANCE, INC. Heading A Physician Owned Independent Practice Association

More information

Quick Reference Guide

Quick Reference Guide Ohio Non-Participating Provider 2014 Physician, Health Care Professional, Facility and Ancillary Quick Reference Guide UHCCommunityPlan.com Important Phone Numbers Provider Services Department 800-600-9007

More information

Transplant Provider Manual. Kaiser Permanente Self-Funded Program

Transplant Provider Manual. Kaiser Permanente Self-Funded Program Transplant Provider Manual Kaiser Permanente Self-Funded Program Welcome to the Kaiser Permanente Self-Funded Program It is our pleasure to welcome you as a Provider for the Kaiser Permanente Self-Funded

More information

Medical Management. G.2 At a Glance. G.3 Procedures Requiring Prior Authorization. G.5 How to Contact or Notify Medical Management

Medical Management. G.2 At a Glance. G.3 Procedures Requiring Prior Authorization. G.5 How to Contact or Notify Medical Management Page1 G.2 At a Glance G.3 Procedures Requiring Prior Authorization G.5 How to Contact or Notify G.6 When to Notify G.11 Case Management Services G.14 Special Needs Services G.16 Health Management Programs

More information

HEALTHSPAN MEDICARE HEALTH PLAN

HEALTHSPAN MEDICARE HEALTH PLAN This is an advertisement. HealthSpan Medicare Advantage for Federal Members (HMO) YOUR GUIDE TO CHOOSING A HEALTHSPAN MEDICARE HEALTH PLAN INCREASE YOUR COVERAGE without increasing your FEHB premium. MAKE

More information

HIPAA Considerations for Small Non-Profits. Jill M. Girardeau July 20, 2011

HIPAA Considerations for Small Non-Profits. Jill M. Girardeau July 20, 2011 HIPAA Considerations for Small Non-Profits Jill M. Girardeau July 20, 2011 Mission of Pro Bono Partnership of Atlanta: To provide free legal assistance to community-based nonprofits that serve low-income

More information

Occupational Health Services

Occupational Health Services Occupational Health Services Workers Compensation MCO Occupational Health Services Workers Compensation MCO This section of the Provider Manual was created to provide you and your staff with basic organizational

More information

Handbook for Urgent Care Center Accreditation

Handbook for Urgent Care Center Accreditation Handbook for Urgent Care Center Accreditation Eligibility A medical center is eligible for an Accreditation survey by the Urgent Care Center Accreditation program when it: Has been providing health care

More information

CHAPTER 7: UTILIZATION MANAGEMENT

CHAPTER 7: UTILIZATION MANAGEMENT OVERVIEW The Plan s Utilization Management (UM) program is collaboration with providers to promote and document the appropriate use of health care resources. The program reflects the most current utilization

More information

Evidence of Coverage

Evidence of Coverage January 1 December 31, 2014 Evidence of Coverage Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of Kaiser Permanente Senior Advantage (HMO) This booklet gives you

More information

Medicare Solutions. Supplement plans. azblue.com. This is a solicitation for insurance. n Compare Medicare. n Learn how to enroll

Medicare Solutions. Supplement plans. azblue.com. This is a solicitation for insurance. n Compare Medicare. n Learn how to enroll Medicare Solutions n Compare Medicare Supplement plans n Learn how to enroll azblue.com This is a solicitation for insurance Contact Customer Service or your licensed sales representative for more information

More information

COMMUNITY REHABILITATION AND TREATMENT CLIENT HANDBOOK. State of Vermont Agency of Human Services Department of Mental Health.

COMMUNITY REHABILITATION AND TREATMENT CLIENT HANDBOOK. State of Vermont Agency of Human Services Department of Mental Health. COMMUNITY REHABILITATION AND TREATMENT CLIENT HANDBOOK State of Vermont Agency of Human Services Department of Mental Health January 2008 Toll-free in the State of Vermont only: 1-888-212-4677 TTY Relay

More information

Evidence of Coverage:

Evidence of Coverage: January 1 December 31, 2015 Evidence of Coverage: Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of HealthSpan Medicare Standard (HMO) This booklet gives you the

More information

YOUR FAST TRACK TO LIVING WELL. A Step Ahead Get answers to your diabetes questions. Member Rights The care and service you need. www.aultcare.

YOUR FAST TRACK TO LIVING WELL. A Step Ahead Get answers to your diabetes questions. Member Rights The care and service you need. www.aultcare. good health SPRING 2014 YOUR FAST TRACK TO LIVING WELL A Step Ahead Get answers to your diabetes questions Member Rights The care and service you need www.aultcare.com IN BRIEF Do You Have Questions? Find

More information

CHAPTER 59A-23 WORKERS COMPENSATION MANAGED CARE ARRANGEMENTS 59A-23.001 Scope. 59A-23.002 Definitions. 59A-23.003 Authorization Procedures.

CHAPTER 59A-23 WORKERS COMPENSATION MANAGED CARE ARRANGEMENTS 59A-23.001 Scope. 59A-23.002 Definitions. 59A-23.003 Authorization Procedures. CHAPTER 59A-23 WORKERS COMPENSATION MANAGED CARE ARRANGEMENTS 59A-23.001 Scope. 59A-23.002 Definitions. 59A-23.003 Authorization Procedures. 59A-23.004 Quality Assurance. 59A-23.005 Medical Records and

More information

MVP SmartFundTM (MSA) A $0 Premium Medicare Medical Savings Account

MVP SmartFundTM (MSA) A $0 Premium Medicare Medical Savings Account MVP SmartFundTM (MSA) A $0 Premium Medicare Medical Savings Account Y0051_2766 Accepted 09/2015 MVP Health Care is excited to offer the SmartFund (MSA) health plan. SmartFund combines a high-deductible

More information

Section 5: Credentialing

Section 5: Credentialing Section 5: Credentialing PRACTITIONER CREDENTIALING CRITERIA...124 All Practitioners... 124 All Physicians... 125 Other Licensed Practitioners... 127 Unlicensed Practitioners... 127 Non-Credentialed Practitioners...

More information

Initial Guidance to States on Exchanges

Initial Guidance to States on Exchanges Initial Guidance to States on Exchanges This guidance document is the first in a series of documents that the Department of Health and Human Services (HHS) intends to publish over the next three years

More information

2015 HMO Evidence of Coverage

2015 HMO Evidence of Coverage hap.org/medicare 2015 HMO Evidence of Coverage HAP Senior Plus (hmo)-henry Ford Individual Plan 006 Option 1 Your Medicare Health Benefits and Services as a Member of HAP Senior Plus (hmo)-henry Ford.

More information

Social Security Disability Benefits

Social Security Disability Benefits Helping Older Persons With Legal & Long-Term Care Problems Social Security Disability Benefits 1. What Disability Programs Are Available From The Social Security Administration (SSA)? SSA offers two major

More information

BlueChoice HealthPlan Medicaid An Overview

BlueChoice HealthPlan Medicaid An Overview BlueChoice HealthPlan Medicaid An Overview 1 Provider Responsibility These are the responsibilities of facilities that help members maintain healthy lifestyles: Provide covered benefits to all members

More information

Small Business Enterprises (SBE) Certification Application

Small Business Enterprises (SBE) Certification Application Small Business Enterprises (SBE) SBE Certification Program Information and Application Mission Statement: The Office of Business Opportunity is committed to creating a competitive and diverse Business

More information

Home Health & Hospice Interactive Voice Response (IVR) System User Guide

Home Health & Hospice Interactive Voice Response (IVR) System User Guide Home Health & Hospice Interactive Voice Response (IVR) System July 2014 2014 Copyright, CGS Administrators, LLC Table of Contents Introduction... 3 Required Information... 3 Menu Options... 4 Claim Status

More information

The Patient-Centered Medical Home & You: Frequently Asked Questions (FAQ) for Patients and

The Patient-Centered Medical Home & You: Frequently Asked Questions (FAQ) for Patients and The Patient-Centered Medical Home & You: Frequently Asked Questions (FAQ) for Patients and Families What is a Patient-Centered Medical Home? A Medical Home is all about you. Caring about you is the most

More information

Healthy Michigan MEMBER HANDBOOK

Healthy Michigan MEMBER HANDBOOK Healthy Michigan MEMBER HANDBOOK 2014 The new name for Healthy 1 TABLE OF CONTENTS WELCOME TO HARBOR HEALTH PLAN.... 2 Who Is Harbor Health Plan?...3 How Do I Reach Member Services?...3 Is There A Website?....

More information

Magellan Healthcare, Inc. Provider Handbook Supplement for US Family Health Plan

Magellan Healthcare, Inc. Provider Handbook Supplement for US Family Health Plan Magellan Healthcare, Inc. Provider Handbook Supplement for US Family Health Plan 2015 Magellan Health, Inc. Table of Contents SECTION 1: INTRODUCTION... 3 Welcome... 3 US Family Health Plan... 3 Covered

More information

Lawrence Livermore National Security (LLNS) Kaiser Permanente Senior Advantage with Health Reimbursement Arrangement

Lawrence Livermore National Security (LLNS) Kaiser Permanente Senior Advantage with Health Reimbursement Arrangement Lawrence Livermore National Security (LLNS) Kaiser Permanente Senior Advantage with Health Reimbursement Arrangement Agenda Welcome Medicare Five Star Rating 2016 Benefit Summary Payment Options and How

More information

H7833_150304MO01. Information for Care Providers about UnitedHealthcare Connected (Medicare- Medicaid Plan) in Harris County, Texas

H7833_150304MO01. Information for Care Providers about UnitedHealthcare Connected (Medicare- Medicaid Plan) in Harris County, Texas H7833_150304MO01 Information for Care Providers about UnitedHealthcare Connected (Medicare- Medicaid Plan) in Harris County, Texas Agenda Connecting Medicare and Medicaid Eligible Members Service Coordination

More information

Beacon Health Strategies Provider eservices Manual

Beacon Health Strategies Provider eservices Manual Provider eservices Manual Elizabeth Pattullo, Chief Executive Officer Timothy Murphy, President Beacon Health Strategies Electronic Data Interchange and eservices User Manual INTRODUCTION... 2 Beacon Health

More information

Your 2015 Health Care Selection Guide Survivor Benefit Applicants

Your 2015 Health Care Selection Guide Survivor Benefit Applicants Your 2015 Health Care Selection Guide Survivor Benefit Applicants 1-888-227-7877 www.strsoh.org Section 1: Welcome This mailing includes the following materials designed to assist you in selecting your

More information

Physician, Health Care Professional, Facility and Ancillary. Provider Manual. For Commercial and ACA Exchange Products

Physician, Health Care Professional, Facility and Ancillary. Provider Manual. For Commercial and ACA Exchange Products Physician, Health Care Professional, Facility and Ancillary Provider Manual For Commercial and ACA Exchange Products Table of Contents Section 1: Section 2: Welcome to IU Health Plans Program Overview

More information

Patient Information. Claims Address: Please also provide Health Insurance information in addition to Work Comp /Auto

Patient Information. Claims Address: Please also provide Health Insurance information in addition to Work Comp /Auto For Office Use Updated By (Initial Here): Mailing Address: Patient Information City, State & Zip: Primary Home Cell Permission to Leave Messages: Yes No Secondary Home Cell Permission to Leave Messages:

More information

Regence Bridge Medigap (Medicare Supplement) Plans

Regence Bridge Medigap (Medicare Supplement) Plans Regence Bridge Medigap (Medicare Supplement) Plans for Clark County, Washington Making sure you have the coverage that is right for you. Regence BlueCross BlueShield of Oregon is an Independent Licensee

More information

TABLE OF CONTENTS. Medical Management. BCBSIL Provider Manual Rev 10/13 1

TABLE OF CONTENTS. Medical Management. BCBSIL Provider Manual Rev 10/13 1 TABLE OF CONTENTS Medical Management... 2 Benefit Pre-certification... 2 Benefit Pre-certification for Inpatient and Ancillary Medical Services... 2 Benefit Pre-certification for Outpatient Medical/Surgical

More information

What Prisoners Need To Know

What Prisoners Need To Know What Prisoners Need To Know What Prisoners Need To Know Social Security and Supplemental Security Income (SSI) payments generally are not payable for months that you are confined to a jail, prison or certain

More information

Table of Contents. Office Information...Page 2. What is the OHC Program?...Page 3. Consumer Rights...Page 4. Complaints...Page 5

Table of Contents. Office Information...Page 2. What is the OHC Program?...Page 3. Consumer Rights...Page 4. Complaints...Page 5 Table of Contents Office Information...Page 2 What is the OHC Program?...Page 3 Consumer Rights...Page 4 Complaints...Page 5 Program Overviews...Page 6 Commonly Asked Questions... Pages 7-11 Home Care

More information

Medicare Part A Coverage

Medicare Part A Coverage Helping Older Persons With Legal & Long-Term Care Problems Medicare Part A Coverage 1. Who Is Eligible For Medicare Part A Hospital Benefits? You are entitled to enroll in Medicare Part A without a monthly

More information

THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) EMPLOYEE TRAINING MANUAL

THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) EMPLOYEE TRAINING MANUAL THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) EMPLOYEE TRAINING MANUAL What is HIPAA? Comprehensive federal legislation regarding health insurance which is comprised of four key areas:

More information

SISC HEALTH BENEFITS 101. South Orange County Community College District August 11, 2015

SISC HEALTH BENEFITS 101. South Orange County Community College District August 11, 2015 1 SISC HEALTH BENEFITS 101 South Orange County Community College District August 11, 2015 2 SISC Schools Helping Schools Established in 1979, Self-Insured Schools of California (SISC) operates as a public

More information

There is no entry fee to participate in this program. Submissions are due back to AIA Ohio by 5 p.m. on June 17, 2011.

There is no entry fee to participate in this program. Submissions are due back to AIA Ohio by 5 p.m. on June 17, 2011. CALL FOR ENTRIES AIA OHIO PUBLIC SERVICE AWARD The AIA Ohio Public Service Award will be granted to an individual who has made a significant impact in their community through public service. To nominate

More information

COMMONWEALTH of VIRGINIA

COMMONWEALTH of VIRGINIA COMMONWEALTH of VIRGINIA Department of Medical Assistance Services HCBCS - Consumer Directed Service Coordination VIRGINIA MEDICAID PROVIDER ENROLLMENT PACKAGE Thank you for your interest in becoming a

More information

Annual Notice of Changes for 2015

Annual Notice of Changes for 2015 Kaiser Permanente Senior Advantage Essential Plus plan (HMO) offered by Kaiser Foundation Health Plan, Inc., Hawaii Region Annual Notice of Changes for 2015 You are currently enrolled as a member of Kaiser

More information

Finding Your Way to Prompt Pay. Texas Department of Insurance

Finding Your Way to Prompt Pay. Texas Department of Insurance Finding Your Way to Prompt Pay TDI s Strategy Education Helping you find the way Enforcement Applicability Applicable to: HMOs Insured PPO Plans Not applicable to: Self-funded funded ERISA plans Indemnity

More information

BCBSTX Support Services: Overview

BCBSTX Support Services: Overview BCBSTX Support Services: Overview Introduction BCBSTX provides support to BlueChoice physicians and other providers through: Provider Customer Service Departments Behavioral Health Services for any mental

More information

Network Facility Handbook

Network Facility Handbook Network Facility Handbook 115 Fifth Avenue New York, NY 10003 www.multiplan.com Table of Contents Introduction... 3 Section One Important Definitions...4 Section Two Network Participation...6 Section Three

More information

Your Health Care Benefit Program. BlueAdvantage Entrepreneur Participating Provider Option

Your Health Care Benefit Program. BlueAdvantage Entrepreneur Participating Provider Option Your Health Care Benefit Program BlueAdvantage Entrepreneur Participating Provider Option GROUP CERTIFICATE RIDER Changes in state or federal law or regulations or interpretations thereof may change the

More information

Provider Selection Criteria for PreferredOne Participating Home Health Care Agencies

Provider Selection Criteria for PreferredOne Participating Home Health Care Agencies Provider Selection Criteria for PreferredOne Participating Home Health Care Agencies General Criteria 1. Practitioner must serve a specialty and/or geographic need for the good of the PreferredOne product

More information

Welcome to the BlueChoice Network

Welcome to the BlueChoice Network Welcome to the BlueChoice BlueChoice Objective The BlueChoice network is composed of hospitals, physicians, health care professionals, and ancillary providers that have contracted with Blue Cross and Blue

More information

Medicare Advantage Your Way. New for 2014!

Medicare Advantage Your Way. New for 2014! Medicare Advantage Your Way. New for 2014! Elderplan is a health plan with Medicare and Medicaid contracts. The benefit information provided herein is a brief summary, not a complete description of benefits.

More information

SMALL GROUP HEALTH BENEFIT SOLUTIONS. ROANOKE 6701 Peters Creek Rd., Ste 101. CHARLOTTESVILLE 1000 Research Park Blvd., Ste 200

SMALL GROUP HEALTH BENEFIT SOLUTIONS. ROANOKE 6701 Peters Creek Rd., Ste 101. CHARLOTTESVILLE 1000 Research Park Blvd., Ste 200 SMALL GROUP HEALTH BENEFIT SOLUTIONS RICHMOND 9881 Mayland Dr. CHARLOTTESVILLE 1000 Research Park Blvd., Ste 200 ROANOKE 6701 Peters Creek Rd., Ste 101 Coventry Health Care is a registered trade name of

More information

Mt Washington Care Center. Cincinnati, Anderson Township and Western Clermont County

Mt Washington Care Center. Cincinnati, Anderson Township and Western Clermont County Mt Washington Care Center 231-4561 24 Hour Skilled Rehabilitation and Nursing Services in Eastern 24 Hour Skilled Rehabilitation and Nursing Services in Eastern Cincinnati, Anderson Township and Western

More information

PLANNING FOR NURSING HOME CARE

PLANNING FOR NURSING HOME CARE PLANNING FOR NURSING HOME CARE My husband and I were adamant that we were never going to a nursing home, so we never bothered to learn anything about them. When I was no longer able to care for my husband,

More information

Horizon Behavioral Health SM Provider Orientation. July 2014

Horizon Behavioral Health SM Provider Orientation. July 2014 Horizon Behavioral Health SM Provider Orientation July 2014 Objectives Overview of Horizon Behavioral Health Overview of Operational Areas Overview of ProviderConnect and NaviNet Claims Processing and

More information

COMMUNITY MERCY HEALTH PARTNERS LIVING OUR MISSION AND VALUES. 2011 Community Benefit Report COMMUNITY MERCY. Health Partners

COMMUNITY MERCY HEALTH PARTNERS LIVING OUR MISSION AND VALUES. 2011 Community Benefit Report COMMUNITY MERCY. Health Partners COMMUNITY MERCY HEALTH PARTNERS LIVING OUR MISSION AND VALUES 2011 Community Benefit Report COMMUNITY MERCY Health Partners Dear Friend, COMMUNITY MERCY Health Partners 100 Medical Center Drive Springfield,

More information

URAC Issue Brief: Best Practices in Network Management

URAC Issue Brief: Best Practices in Network Management 1220 L Street, NW, Suite 400 Washington, DC 20005 202.216.9010 Best Practices in Network Management Introduction As consumers enroll in health plans through newly formed Health Insurance Marketplaces,

More information

RULES OF THE STATE OF FLORIDA DEPARTMENT OF ELDER AFFAIRS AGING RESOURCE CENTERS CHAPTER 58B-1

RULES OF THE STATE OF FLORIDA DEPARTMENT OF ELDER AFFAIRS AGING RESOURCE CENTERS CHAPTER 58B-1 RULES OF THE STATE OF FLORIDA DEPARTMENT OF ELDER AFFAIRS AGING RESOURCE CENTERS CHAPTER 58B-1 58B-1.001 Definitions. In addition to the definitions included in Chapter 430, F.S., the following terms shall

More information

Important Benefi ts for Medicaid Eligible Children: EPSDT EARLY & PERIODIC SCREENING DIAGNOSIS & TREATMENT. Ohio Legal Rights Service

Important Benefi ts for Medicaid Eligible Children: EPSDT EARLY & PERIODIC SCREENING DIAGNOSIS & TREATMENT. Ohio Legal Rights Service Important Benefi ts for Medicaid Eligible Children: EPSDT EARLY & PERIODIC SCREENING DIAGNOSIS & TREATMENT Ohio Legal Rights Service On October 26, 2005, Ohio Legal Rights Service (OLRS) fi led a lawsuit

More information

Online Provider/Pharmacy Directory: New Guidelines and Requirements

Online Provider/Pharmacy Directory: New Guidelines and Requirements Vol. 3, No. 3 PROVIDER PULSE October - 2015 In This Issue New Guidelines... page 1 Provider Portal...page 2 Part D...page 2 Medical Services... page 3 Quality...page 4 Claims/New Rep...page 5 Online Provider/Pharmacy

More information

Rights and Responsibilities upon disenrollment with UPMC for Life

Rights and Responsibilities upon disenrollment with UPMC for Life Rights and Responsibilities upon disenrollment with UPMC for Life SECTION 1: Introduction Ending your membership with UPMC for Life may be voluntary (your own choice) or involuntary (not your own choice):

More information

PATIENT PORTAL ACCESS

PATIENT PORTAL ACCESS PATIENT PORTAL ACCESS Thank you for choosing Clarinda Regional Health Center as your medical services provider. The mission at CRHC is to provide exceptional, individualized healthcare to each patient

More information

Behavioral Health (MAPSI) Utilization Management Program Components

Behavioral Health (MAPSI) Utilization Management Program Components Behavioral Health (MAPSI) Utilization Management Program Components Payer Name: Printed Name of Payer Representative: Phone: Is this document applicable to all groups? Yes No If no, please indicate specific

More information

Administrative Review of Certain Electronic Health Record Incentive Program Determinations

Administrative Review of Certain Electronic Health Record Incentive Program Determinations Administrative Review of Certain Electronic Health Record Incentive Program Determinations The Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs Final Rule (Final Rule), C.F.R 42

More information

NEHEN. Member-Directed HIE. Sira Cormier, Program Director June 8, 2012. MHDC - Health Information Exchange Conference. NEHEN & CSC Proprietary

NEHEN. Member-Directed HIE. Sira Cormier, Program Director June 8, 2012. MHDC - Health Information Exchange Conference. NEHEN & CSC Proprietary Member-Directed HIE Sira Cormier, Program Director June 8, 2012 & CSC Proprietary MHDC - Health Information Exchange Conference Organizational Overview Established in 1998 New England Healthcare Exchange

More information

Health Resources in Action, Inc. Information and Referral Specialist Position Announcement May 2015

Health Resources in Action, Inc. Information and Referral Specialist Position Announcement May 2015 Health Resources in Action, Inc. Information and Referral Specialist Position Announcement May 2015 95 Berkeley Street, 2 nd Floor Boston, MA 02116 617.451.0049 Fax 617.451.0062 TTY: 617.451.0007 www.hria.org

More information

Thank you for considering BlueShield of Northeastern New York for your Medicare Advantage needs. (H3384), and BlueSaver MSA (H9788) plans.

Thank you for considering BlueShield of Northeastern New York for your Medicare Advantage needs. (H3384), and BlueSaver MSA (H9788) plans. Dear Neighbor: Thank you for considering BlueShield of Northeastern New York for your Medicare Advantage needs. Why you re receiving this letter Enclosed are the Centers for Medicare and Medicaid Services

More information

More than a score: working together to achieve better health outcomes while meeting HEDIS measures

More than a score: working together to achieve better health outcomes while meeting HEDIS measures NEVADA ProviderNews Vol. 3 2014 More than a score: working together to achieve better health outcomes while meeting HEDIS measures We know you ve heard of Healthcare Effectiveness Data and Information

More information

Radiology Prior Authorization Program Frequently Asked Questions for the UnitedHealthcare Community Plan

Radiology Prior Authorization Program Frequently Asked Questions for the UnitedHealthcare Community Plan Radiology Prior Authorization Program Frequently Asked Questions for the UnitedHealthcare Community Plan 1. What is the UnitedHealthcare Radiology Prior Authorization Program? Acting on behalf of our Medicaid

More information

A Bill Regular Session, 2015 SENATE BILL 318

A Bill Regular Session, 2015 SENATE BILL 318 Stricken language would be deleted from and underlined language would be added to present law. Act 0 of the Regular Session 0 State of Arkansas 0th General Assembly As Engrossed: S// A Bill Regular Session,

More information

LIVING OUR MISSION AND VALUES. CMHP 2012 Community Benefit Report COMMUNITY MERCY. Health Partners

LIVING OUR MISSION AND VALUES. CMHP 2012 Community Benefit Report COMMUNITY MERCY. Health Partners LIVING OUR MISSION AND VALUES CMHP 2012 Community Benefit Report COMMUNITY MERCY Health Partners Dear Friend, An unprecedented number of families in our community have learned the value of having access

More information

2013 Provider Administrative Manual

2013 Provider Administrative Manual HealthSpan, Inc. l 225 Pictoria Drive, Suite 320 l Cincinnati, OH 45246 513-551-1440 l 1-888-914-7726 www.healthspannetwork.com TABLE OF CONTENTS I. Overview II. III. IV. Contacts (Informational sheet

More information

2015 Optimum Healthcare Sales Presentation Video Transcript-

2015 Optimum Healthcare Sales Presentation Video Transcript- 2015 Optimum Healthcare Sales Presentation Video Transcript- H5594_15SalesPresVidv2_CMS_Approved Welcome to this presentation on Optimum HealthCare s Medicare Advantage Plans. Today you will learn about

More information

SMALL BUSINESS GROUP ENROLLMENT AND CHANGE FORM

SMALL BUSINESS GROUP ENROLLMENT AND CHANGE FORM SMALL BUSINESS GROUP ENROLLMENT AND CHANGE FORM Medical and Life/AD&D plans are provided by Health Net of California, Inc. and/or Health Net Life Insurance Company (together, the Health Net Entities ).

More information

Services Available to Members Complaints & Appeals

Services Available to Members Complaints & Appeals Services Available to Members Complaints & Appeals Blue Cross and Blue Shield of Texas (BCBSTX) resolves complaints and appeals related to any aspect of service provided by itself or any subcontractor

More information

IPhysician ID# ILanuage Preference ~ HEALTH INSURANCE ELECTION FORM MEDICARE. Page 1 of 4 for applicant to complete

IPhysician ID# ILanuage Preference ~ HEALTH INSURANCE ELECTION FORM MEDICARE. Page 1 of 4 for applicant to complete ELECTION FORM Page 1 of 4 for applicant to complete PLEASE COMPLETE THE INFORMATION BELOW Last Name First Name IMiddle Initial Gender O M O F Permanent residence street address (Street Address ONLY - No

More information