Provider Manual + HEALTHSPAN
|
|
|
- Buddy Tyler
- 7 years ago
- Views:
Transcription
1 Provider Manual + HEALTHSPAN
2 Section 1: HealthSpan Provider Manual Medical Care Program For Fully Insured + HEALTHSPAN
3 Table of Contents WELCOME...4 INTRODUCTION...4 SECTION 1: HEALTHSPAN MEDICAL CARE PROGRAM FOR FULLY INSURED PRODUCTS HISTORY HealthSpan Mission Statement HealthSpan Values HealthSpan Organizational Structure...7 3
4 Welcome It is our pleasure to welcome you as a Plan Provider with 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 Services (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 Introduction This Provider Manual ( Manual ) for Fully Insured products 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. This Provider Manual and the Medicare Advantage Provider Manual are posted on the HealthSpan 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 the date posted thereon, unless otherwise required by your Agreement or applicable Law. If any revisions constitute a Material Change to your Agreement with HealthSpan, written notification will be sent in writing to your office by certified mail, 90 days in advance of the change. If there is a conflict between this Manual and your Agreement, the terms of your Agreement will control. All defined terms in Section 12 are capitalized throughout this Provider 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: 4
5 Option 1: Option 2: Option 3: Option 4: Leave a message for a callback within business hours. 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. If a HealthSpan Member needs to be admitted to a hospital, select option 3. Option 3 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 4. Option 4 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 Network Associate in Cincinnati or Cleveland: 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. See Section 2 of this Provider Manual for a contact list of Network Associates, by territory. 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, Monday through Thursday, 8:15 a.m. to 5 p.m., and 5
6 Friday, 9 a.m. to 5 p.m. at The hearing/speech impaired may call (toll-free TTY). 6
7 Section 1: HealthSpan Medical Care Program for Fully Insured 1.1 History HealthSpan is a division of Mercy Health, formerly Catholic Health Partners, and the largest health system within the State of Ohio. Mercy Health operates more than 250 health facilities in Ohio and Kentucky, 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 HealthSpan Organizational Structure HealthSpan offers Fully Insured Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) products throughout the State of Ohio. The HealthSpan administrative headquarters are located in Cincinnati, Ohio. HealthSpan Physician networks include the following Providers: Community Mercy Health Partners in Springfield, Ohio. Humility of Mary Health Partners in Youngstown, Ohio. Mercy Health Partners in Lorain County, Ohio. Mercy Health Partners-Kentucky in Paducah, Kentucky. Mercy Health Partners-Southwest Ohio in Cincinnati, Ohio. Mercy Health Partners in Toledo, Ohio. St. Rita s Health Partners in Lima, Ohio. For more information regarding HealthSpan, view the website online at healthspan.org/providers/north-coast. 7
Medicare Advantage Provider Manual
Medicare Advantage Provider Manual Table of Contents WELCOME... 3 INTRODUCTION... 3 SECTION 1: HEALTHSPAN MEDICAL CARE PROGRAM... 5 1.1 HISTORY... 5 1.1.1 HealthSpan Mission Statement...5 1.1.2 HealthSpan
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
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
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
Gilsbar 360 Alliance PROVIDER MANUAL. Gilsbar. www.gilsbar360alliance.com
Gilsbar 360 Alliance PROVIDER MANUAL Gilsbar www.gilsbar360alliance.com Dear Provider: Gilsbar is building a PPO network that gives providers and employers the opportunity to truly work together. We ve
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
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
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...
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
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
Minority Administrative Fellowship Program
FUELING THE HEALTH CARE PIPELINE Minority Administrative Fellowship Program Two Year Experience Leadership Development Project Management Succession Planning Department Rotation Mentoring TABLE OF CONTENTS
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
Medicare and Your CalPERS Health Benefits. Laurie: Welcome to Medicare and Your CalPERS Health Benefits webinar.
Date: October 21, 2015 Presenter: Jim Cale and Laurie Daniels Laurie: Welcome to Medicare and Your CalPERS Health Benefits webinar. Jim: In this webinar, we ll cover information you may need to know regarding
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
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
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:
Introduction and Overview of HCO Program
Introduction and Overview of HCO Program To meet the requirements of Article 8 9771.70, First Health has designed this manual for The First Health Network providers participating in The First Health/CompAmerica
Evidence of Coverage:
January 1 December 31, 2010 Evidence of Coverage: Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of Advantra Option 2 This booklet gives you the details about your
UH00864 (9/07) Unity Health Plans Insurance Corporation (800) 362-3310. Unity Customer Service. unityhealth.com. Sauk City, WI 53583
840 Carolina Street Sauk City, WI 53583 unityhealth.com Unity Customer Service (800) 362-3310 UH00864 (9/07) New Member Kit A guide to getting started Welcome to Unity Health Insurance Topic Overview Online
Healthy Michigan MEMBER HANDBOOK
Healthy Michigan MEMBER HANDBOOK 2015 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?....
California Provider Reference Manual Introduction and Overview of Medical Provider Networks (CA MPNs)
California Provider Reference Manual Introduction and Overview of Medical Provider Networks (CA MPNs) Coventry/First Health has designed this manual for The Coventry/First Health Network providers participating
Self-Funded Provider Manual Section 3 Member Eligibility and Benefits Determination Product Descriptions Drug Benefits and Formulary
Self-Funded Provider Manual Section 3 Member Eligibility and Benefits Product Descriptions Drug Benefits and Formulary Self-Funded Provider Manual 1 Table of Contents SECTION 3: ELIGIBILITY AND BENEFITS
Public Service Health Care Plan
Public Service Health Care Plan Completing positive enrolment Table of contents Introduction... i Have the following information available...1 Safeguarding your privacy...1 PSHCP details.....................................................................................
Radiology Prior Authorization Program Frequently Asked Questions (FAQ) For AmeriChoice by UnitedHealthcare, Tennessee
Radiology Prior Authorization Program Frequently Asked Questions (FAQ) For AmeriChoice by UnitedHealthcare, Tennessee 1. What is the AmeriChoice Radiology Prior Authorization Program? Acting on behalf
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
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
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
The City of Subiaco s commitment to you... 1. Community vision... 1. Corporate vision... 1. Our values... 1. Face to face... 2. On the telephone...
Table of contents Introduction... 1 The City of Subiaco s commitment to you... 1 Visions, mission and values... 1 Community vision... 1 Corporate vision... 1 Our values... 1 Service standards you can expect...
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
Undergraduate Student Health Insurance Plan (USHIP) Benefits 2015-2016
Undergraduate Student Health Insurance Plan (USHIP) Benefits 2015-2016 For your insurance ID card or additional information on this plan, visit: www.4studenthealth.com/uci How USHIP Works For UC Irvine
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,
Important information about our provider directory
Important information about our provider directory This online directory provides a list of Aetna Medicare Plan (HMO) (PPO) network providers. To get detailed information about your health care coverage,
Quiroz Adult Medicine Clinic, P.A. General Office Policies
General Office Policies Thank you for choosing Quiroz Adult Medicine Clinic P.A. (QAMC) as your health care provider. The following general office policies are provided to understand our office protocols
Handbook for Home Health Agencies
Handbook for Home Health Agencies Chapter R-200 Policy and Procedures For Home Health Agencies Illinois Department of Public Aid CHAPTER R-200 Home Health Agency Services TABLE OF CONTENTS FOREWORD R-200
Physical Medicine Services Registration and Authorization Program Guide for Prevea360 Providers
Physical Medicine Services Registration and Authorization Program Guide for Prevea360 Providers Introduction... 3 Authorization Program Overview... 3 Prevea360 Health Plans Affected... 3 The Authorization
ANNUAL NOTICE OF CHANGES FOR 2016
Cigna-HealthSpring Preferred (HMO) offered by Cigna-HealthSpring ANNUAL NOTICE OF CHANGES FOR 2016 You are currently enrolled as a member of Cigna-HealthSpring Preferred (HMO). Next year, there will be
CMS Provides ACMA with FAQ Document Addressing Case Managers Concerns Surrounding the IM Second Notice
CMS Provides ACMA with FAQ Document Addressing Case Managers Concerns Surrounding the IM Second Notice The Centers for Medicare & Medicaid Services (CMS) provided ACMA with the following frequently asked
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
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
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
MEDICARE FACTS 2014 MEDICARE AND YOUR ALCATEL-LUCENT COVERAGE
MEDICARE FACTS 2014 MEDICARE AND YOUR ALCATEL-LUCENT COVERAGE Use this guide to learn more about Medicare and how it works with your Alcatel-Lucent medical and prescription drug coverage. For Formerly
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
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
Blue Choice PPO SM Support Services
SM Support Services In this Section The following topics are covered in this section. Topic Page Blue Choice PPO Overview A 2 Blue Choice PPO Geographical Regions A 2 Blue Choice PPO Support Areas A 2
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
Special Needs Plan. Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of True Blue Special Needs Plan (HMO).
2010 Evidence of Coverage HMO Special Needs Plan Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of True Blue Special Needs Plan (HMO). This booklet gives you the
Updated as of 05/15/13-1 -
Updated as of 05/15/13-1 - GENERAL OFFICE POLICIES Thank you for choosing the Quiroz Adult Medicine Clinic, PA (QAMC) as your health care provider. The following general office policies are provided to
The Hartford s California Workers Compensation Medical Provider Network (MPN) Accessing Anthem Blue Cross Prudent Buyer PPO
Employer Implementation Guide Topics Covered in the Guide: Workers Compensation MPN Networks in CA How It Works The Employer s Role Implementation Steps Dealing with Workplace Injuries Employee Rights
Clinic Name and Location: 4. Clinic has specific written protocols or guidelines for treatment of TB:
TB Clinic Survey Form Clinic Name and Location: PATIENT POPULATION 1. Number of Patients eligible for initiation of TB Treatment: 2. Number of Patients Started on TB Treatment: 3. Number of these Patients
PENNSYLVANIA DEPARTMENT OF HEALTH BUREAU OF MANAGED CARE Interim APPLICATION FOR CERTIFICATION AS A UTILIZATION REVIEW ENTITY
...in pursuit of good health PENNSYLVANIA DEPARTMENT OF HEALTH BUREAU OF MANAGED CARE Interim APPLICATION FOR CERTIFICATION AS A UTILIZATION REVIEW ENTITY NOTE: Act 68 gives utilization review (UR) entities,
Licensed Counselors (LPCC)
CREDENTIALING Molina Healthcare of Ohio s credentialing process is designed to meet the standards of the National Committee for Quality Assurance (NCQA). In accordance with those standards, Molina Healthcare
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
Sacramento County Medi-Cal Mental Health Services
GUIDE TO Sacramento County Medi-Cal Mental Health Services Important Telephone Numbers Emergency 911 ACCESS (916) 875-1055 ACCESS toll free/24-hours (888) 881-4881 Psychiatric Emergency/Urgent Services
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
AGENCY FOR HEALTH CARE ADMINISTRATION HEALTH QUALITY ASSURANCE BUREAU OF MANAGED HEALTH CARE 2727 Mahan Drive Tallahassee Florida 32308
AGENCY FOR HEALTH CARE ADMINISTRATION HEALTH QUALITY ASSURANCE BUREAU OF MANAGED HEALTH CARE 2727 Mahan Drive Tallahassee Florida 32308 WORKERS COMPENSATION MANAGED CARE ARRANGEMENT SURVEY REPORT NAME
Delta Dental Insurance Company. VIVA Medicare Plus Extra Care Dental Program. Evidence of Dental Coverage
Delta Dental Insurance Company VIVA Medicare Plus Extra Care Dental Program Evidence of Dental Coverage January 1, 2008 to December 31, 2008 If you have questions about your dental benefits, you may contact
MEDICAL MANAGEMENT OVERVIEW MEDICAL NECESSITY CRITERIA RESPONSIBILITY FOR UTILIZATION REVIEWS MEDICAL DIRECTOR AVAILABILITY
4 MEDICAL MANAGEMENT OVERVIEW Our medical management philosophy and approach focus on providing both high quality and cost-effective healthcare services to our members. Our Medical Management Department
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,
Section 4: Physicians and Providers
Section 4: Physicians and Providers 4.1 Eligible Providers The following physicians and practitioners are eligible to be considered as PacificSource participating providers, provided they meet credentialing
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
Anthem Secure Email Mailbox Setup
Anthem Secure Email Mailbox Setup What is Secure e-review Secure e-review is a way for providers and facilities to relay information electronically to Anthem for pre-authorizations No need to fax or phone.
Claims and Billing Process. AHCCCS Provider Identification Number and NPI Number
Claims and Billing Process AHCCCS Provider Identification Number and NPI Number All United Healthcare Community Plan providers requesting reimbursement for services must be properly registered with AHCCCS
EDI Solutions Your guide to getting started -- and ensuring smooth transactions anthem.com/edi
EDI Solutions Your guide to getting started -- and ensuring smooth transactions anthem.com/edi 00175CEPEN (04/12) This brochure is a helpful EDI reference for both new and experienced electronic submitters.
POLICY AND PROCEDURE POLICY NUMBER: CHS-RMC-03 POLICY LEVEL: CHS
Payment and Healthcare Assistance Policy RESPONSIBLE DEPARTMENT: Finance PREPARED BY: Scott Kitchen Director Clinical and Business Intelligence POLICY NUMBER: CHS-RMC-03 POLICY LEVEL: CHS APPROVED BY:
Dear Doctor: Very truly yours, Rosemary Gould Vice-President
ADMINISTRATIVE SERVICES ONLY, INC. SELF-INSURED DENTAL SERVICES BENEFIT PLAN ADMINISTRATORS 303 Merrick Road Post Office Box 9010 Lynbrook, NY 11563-9010 Dear Doctor: Welcome to the network of participating
Early Intervention Central Billing Office. Provider Insurance Billing Procedures
Early Intervention Central Billing Office Provider Insurance Billing Procedures May 2013 Provider Insurance Billing Procedures Provider Registration Each provider choosing to opt out of billing for one,
Appeals Provider Manual 15
Table of Contents Overview... 15.1 Commercial Member appeals... 15.1 Self-insured groups... 15.1 Traditional/CMM Members... 15.1 Who may appeal... 15.1 How to file an internal appeal on behalf of the Member...
Regence Medicare Advantage PPO Plans. Regence BlueCross BlueShield of Oregon is an Independent Licensee of the Blue Cross and Blue Shield Association
DECISION GUIDE 2015 Medicare Advantage PPO Plans BlueCross BlueShield of Oregon is an Independent Licensee of the Blue Cross and Blue Shield Association Y0062_07978 Approved OR PPO 2015 GET STARTED READ.
APRIL 2015 SECTION I - 1. Section I: Introduction and Overview
Section I: Introduction and Overview About Us... I-2 Resources... I-3 Sharp Health Plan s Responsibilities... I-4 Service Area... I-4 Compliance Program... I-4 Health Care Fraud, Waste, and Abuse Prevention...
REQUEST FOR PROPOSAL. Lobbying Services. Release Date: March 2, 2016 RFP Response Deadline: March 14, 2016
REQUEST FOR PROPOSAL Lobbying Services Release Date: March 2, 2016 RFP Response Deadline: March 14, 2016 Submit to: Ohio State Association of Nurse Anesthetists Peggy Blankenship, CAE Executive Director
Basics of the Healthcare Professional s Revenue Cycle
Basics of the Healthcare Professional s Revenue Cycle Payer View of the Claim and Payment Workflow Brenda Fielder, Cigna May 1, 2012 Objective Explain the claim workflow from the initial interaction through
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
Utilization Review Determinations Timeframe
Utilization Review s Timeframe The purpose of this chart is to reference utilization review determination timeframes. It is not meant to completely outline the UR process. See Policy: Prospective, Concurrent,
Care Management. BCN Provider Manual. Contents
BCN Provider Manual Care Management Contents Hyperlinks to important information... 8-1 Overview of BCN Care Management... 8-2 Managing BCN members care... 8-5 The BCN referral process... 8-7 BCN clinical
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
Medicare Advantage Plans
2016 BlueCross BlueShield of Western New York Medicare Advantage Plans Gloria and Anai, Members Y0086_MRK1528rev2 Accepted The benefits of Blue Understanding Medicare and choosing a health plan are not
Greensboro, NC October 4-5, 2012. North Carolina Health Insurance Institute
Greensboro, NC October 4-5, 2012 North Carolina Health Insurance Institute About MedCost Over 29 years of experience providing employers throughout the Carolinas with the best access to the best health
Learning Objectives. What is a Billing Agent? Direct Payment to Providers
Learning Objectives Share basic Florida Medicaid policy regarding Billing Agents Improve compliance with Florida Medicaid policy Inform Billing Agents on how to access resources and assistance Developed
FedEx Web Services Certification Guide
FedEx Web Services Certification Guide May 2016 Payment You must remit payment in accordance with the FedEx Service Guide, tariff, service agreement or other terms or instructions provided to you by FedEx
FREQUENTLY ASKED QUESTIONS ID CARDS / ELIGIBILITY / ENROLLMENT
FREQUENTLY ASKED QUESTIONS ID CARDS / ELIGIBILITY / ENROLLMENT BENEFIT INFORMATION CLAIMS STATUS/INFORMATION GENERAL INFORMATION PROVIDERS THE SIGNATURE 90 ACCOUNT PLAN THE SIGNATURE 80 PLAN USING YOUR
AvMed s Physician-to- Physician Referral Program
AvMed s Physician-to- Physician Referral Program Quick Reference Guide For Primary Care Physicians 1 P age Introduction Primary Care Physicians (PCPs) play a critical role in the health of our Medicare
Provider Claims Billing
Provider Claims Billing Objective At the end of this session, you should be able to recognize the importance of using Harvard Pilgrim s online tools and resources to manage the revenue cycle: Multiple
GOlden VITAlITY. Welcome to Golden Vitality. This FREE program is designed to help you achieve a healthy lifestyle.
Olden VIAlIY Y L I F S H Welcome to olden Vitality. his F program is designed to help you achieve a healthy lifestyle. As a olden Vitality participant you re eligible to receive up to $200 in gym or fitness
DELTA DENTAL PPO+Premier Participating Independent Dental Hygienist Agreement
DELTA DENTAL PPO+Premier Participating Independent Dental Hygienist Agreement THIS AGREEMENT, made and entered into this day of, 20 by and between Colorado Dental Service, Inc. d/b/a Delta Dental of Colorado,
Transportation for health care appointments just got easier with
Transportation for health care appointments just got easier with Molina Medicare! With Molina Medicare Options Plus HMO SNP Plan, we offer the added benefit of non-emergency transportation to get you to
For Members of Large Group HMO_POS Plans. Florida Hospital Care Advantage
For Members of Large Group HMO_POS Plans Florida Hospital Care Advantage Member Guidebook 6450 US Highway 1, Rockledge, FL 32955 Toll-free 1.844.522.5279 TDD/TTY relay 1.800.955.8771 Monday-Friday, 8 am
RE: Request for Proposals (RFP) for Community Learning Projects for Leadership Greensboro Class 2016
Date: July 15, 2015 To: Nonprofit Organizations, Civic Organizations, Governmental Institutions and Educational Institutions RE: Request for Proposals (RFP) for Community Learning Projects for Leadership
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
Understanding Hospice Care. A Guide for Patients and Families
Understanding Hospice Care A Guide for Patients and Families CONTACT AND REFERRALS 24-hour phone 630.665.7000 Physician referrals 630.665.7006 Fax 630.665.7371 TTY for the hearing impaired 630.933.4833
New Patient Handbook
New Patient Handbook Table of contents Welcome...2 Choosing a Physician...3 Scheduling or Canceling an Appointment...3 Leaving a Message for Your Doctor...3 Refilling Your Medication...3 Services...4 Customer
Administrative Hospital-wide Policy and Procedure
Policy: Policy Number: Administrative Hospital-wide Policy and Procedure Charity Care and Financial Assistance Joseph S. Gordy, CEO Flagler Hospital Originator: Coordinating Departments: Signature: Chief
Provider Handbook Supplement for Blue Shield of California (BSC)
Magellan Healthcare, Inc. * Provider Handbook Supplement for Blue Shield of California (BSC) *In California, Magellan does business as Human Affairs International of California, Inc. and/or Magellan Health
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
Non-Hospital Charitable Care and Financial Assistance Policy
Non-Hospital Charitable Care and Financial Assistance Policy Mayo Clinic s mission is to provide the best care to every patient through integrated clinical practice, education and research. Mayo Clinic
Evidence. of Coverage. ATRIO Gold Rx (Rogue) (PPO) Member Handbook. Serving Medicare Beneficiaries in Josephine and Jackson Counties
2016 Evidence of Coverage ATRIO Gold Rx (Rogue) (PPO) Member Handbook Serving Medicare Beneficiaries in Josephine and Jackson Counties H6743_017_EOC_16 CMS Accepted January 1 December 31, 2016 Evidence
FEHB Program Carrier Letter All Carriers
FEHB Program Carrier Letter All Carriers U.S. Office of Personnel Management Insurance Operations Letter No. 2010-20 Date: October 19, 2010 Fee-for-Service [16] Experience-rated HMO [16] Community-rated
Records of Student Nurses Association District 10 FSC-32. (formerly MS 172)
Records of Student Nurses Association District 10 FSC-32 (formerly MS 172) Wright State University Special Collections and Archives Processed by: Xiuzhi Zhou (Transferred to HSL Archives 10/9/89) Introduction
Florida Managed Care Arrangement. Employer s Handbook
Florida Managed Care Arrangement Employer s Handbook Contents Introduction... 1 Employer Guidelines... 2 Identification Form... 5 Employee Information... 6 Coventry s & HDi s Responsibilities... 8 Frequently
TG 47-01. TRANSITIONAL GUIDELINES FOR ISO/IEC 17021-1:2015, ISO 9001:2015 and ISO 14001:2015 CERTIFICATION BODIES
TRANSITIONAL GUIDELINES FOR ISO/IEC 17021-1:2015, ISO 9001:2015 and ISO 14001:2015 CERTIFICATION BODIES Approved By: Senior Manager: Mpho Phaloane Created By: Field Manager: John Ndalamo Date of Approval:
FEEL BETTER ABOUT YOUR CHOICES
2016 FEEL BETTER ABOUT YOUR CHOICES CHOOSE WELLCARE. CHOOSE A PLAN TO FIT YOUR NEEDS. Information on individual and family plans inside. Kentucky Boone, Bullitt, Campbell, Clay, Fayette, Harlan, Jefferson,