Harbor s Payment to Providers Policy and Procedures is available on the Harbor website and will be updated annually or as changes are necessary.

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Harbor s Payment to Providers Policy and Procedures is available on the Harbor website and will be updated annually or as changes are necessary."

Transcription

1 Original Approval Date: 01/31/2006 Page 1 of 10 I. SCOPE The scope of this policy involves all Harbor Health Plan, Inc. (Harbor) contracted and non-contracted Practitioners/Providers; Harbor s Contract and Credentialing Committee; Provider Services and Claims Department. II. POLICY Harbor maintains its Payment to Providers Policy and Procedures for processing all Practitioners/Providers claims for services provided to eligible Medicaid Members. Harbor shall make timely payments to all Providers for covered services rendered to eligible Members when submitted as a clean claim and is in compliance with established Uniform Billing and Michigan Department of Community Health (MDCH) submission requirements. Harbor shall meet HIPAA and MDCH guidelines and requirements for electronic capacity, including compliance with HIPAA Transactions and Code Sets Standards. Harbor s Payment to Providers Policy and Procedures is available on the Harbor website and will be updated annually or as changes are necessary. III. DEFINITIONS: A. Clean Claim: a claim that at a minimum identifies or describes all of the following: 1. The Patient s Identification number, name, address, and date of birth; 2. The day, month, and year the service was rendered; 3. A description of the rendered service using the Current Procedure Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), International Classification of Disease (ICD-9-CM) Page 1 of 10

2 Original Approval Date: 01/31/2006 Page 2 of 10 universal identifying procedure code, as designated Center for Medicare/Medicaid Services (CMS) and National Uniform Billing Committee (NUBC). 4. The Rendering Provider s Name and National Provider Identification number (NPI), the Billing Provider s Name, Tax Identification number, NPI number, and the location of the service; 5. Practitioners/Providers certification as required under MCL b(17) (that a claim for payment for services rendered to a medically indigent individual is true, accurate, prepared with the knowledge and consent of the Provider, and does not contain untrue, misleading, or deceptive information) and identifying information required by MCL b(21) (Practitioners/Providers must identify each attending, referring, or prescribing physician, dentist, or other practitioner by means of a program identification number on each claim or adjustment); 6. Substantiation of medical necessity and appropriateness of service; 7. An authorization number, if applicable; and 8. Any additional documentation required by Harbor, if applicable. B. HIPAA: The Health Insurance Portability and Accountability Act of 1996, Public Law C. Practitioner / Provider: a licensed professional, physician, nurse practitioner, hospital, group practice, nursing home, pharmacy, home health care agency, durable medical equipment agency, maternal infant health provider or any individual or group of individuals that provides a health care service. IV. PROCEDURE Delegated Responsibilty Page 2 of 10

3 Original Approval Date: 01/31/2006 Page 3 of 10 A. General Requirements 1. All Providers are responsible for knowing what services are covered under Medicaid. All professional services must be submitted on a CMS-1500 claim form. Facility claims must be submitted on a UB-04 claim form. 2. All claims must be submitted electronically or mailed to the Harbor address as instructed in the Provider Manual 3. Providers are responsible for verifying member s eligibility prior to rendering services. Harbor will not pay for any services rendered to a Medicaid recipient prior to his/her effective date except services for a newborn that is retroactively enrolled back to the date of birth. Payments will not be made for Members after the date of disenrollment except for an inpatient hospitalization that is concurrent with the date of disenrollment. 4. Providers are responsible for obtaining the required Prior Authorization/Referral prior to rendering services. Prior authorization policy and procedures are outlined in the Health Care Management / Utilization Management Program. 5. Harbor shall inform Providers of its prior authorization policy and procedures including elements needed to substantiate medical necessity of a claim. 6. Providers who are not contracted with Harbor must follow all Harbor guidelines and procedures for the filing of clean claims. 7. Claims submitted for Medicaid Members for which another known payment source is available are not considered to be clean claims until the Practitioners/Providers has exhausted all other sources of payment before billing Harbor. Page 3 of 10

4 Original Approval Date: 01/31/2006 Page 4 of Harbor or its Practitioners/Providers shall not require co-payments, patient-pay amounts, or other cost-sharing arrangements unless authorized by MDCH. Providers shall not bill Members for the difference between the Provider s charge and Harbor s payment for covered services. Providers will not seek or accept additional or supplemental payment from a Member, his/her family, or representative, in addition to the amount paid by Harbor even if the Member has signed an agreement to do so. These provisions also apply to out-of-network Providers. 9. Members shall not be held liable for any of the following provisions (consistent with 42 CFR and 42 CFR ): a. Harbor s debts, in case of insolvency; b. Covered services provided to the Member for which the State did not pay Harbor; c. Covered services provided to the Member for which the State or Harbor does not pay the Practitioners/Providers due to contractual, referral or other arrangement; or d. Payments for covered services furnished under a contract, referral or other arrangement, to the extent that those payments are in excess of the amount that the Member would owe if Harbor provided the services directly. 10. Harbor may use a pre and post-payment review methodology to assure claims have been paid appropriately. B. Claims Processing 1. Clean Claim received by Harbor will be stamped with the date received and entered into Harbor s Management Information System (MIS) within an appropriate time frame to ensure payment within 45 Page 4 of 10

5 Original Approval Date: 01/31/2006 Page 5 of 10 days of receipt. When the claim is entered into Harbor s MIS, a Claim Reference Number is assigned. This Claim Reference Number is used to track the claim. 2. Defect claims will be stamped with the date received and returned to the Practitioner/Provider with notification of the defect within 30 days of receipt. 3. New claims must be submitted to Harbor within 1 year (365 days) of the service date. New claims submitted past the filing limit must have supporting documentation that explains the reasons for late filing. 4. Replacement/Corrected claims that are over the filing limit must have continuous activity to be considered for payment; and must be submitted within 180 days of the original payment/rejection date. 5. Harbor grants exceptions to the claim submission filing requirement in the following circumstances: a. The Practitioners/Providers received erroneous written instructions from Harbor staff; b. Harbor staff failed to enter authorization; or issued an erroneous prior authorization; c. Other documented administrative errors by Harbor or its contractors; d. Eligibility was established retroactively; e. Processing of primary insurance was delayed; and f. Practitioners/Providers received incorrect billing information from the patient and billed the Medicaid program first. Page 5 of 10

6 Original Approval Date: 01/31/2006 Page 6 of All claims processed through Harbor s MIS undergo a pre-payment audit review prior to each check-run to verify the accuracy of patient demographic information; diagnoses; services (CPT/HCPCS); rendering and billing provider information; and also to ensure that current Medicaid Fee Schedules, and/or specific provider contract rates are paid appropriately. 7. Claim processing errors identified in the pre-payment audit review are corrected by the processor that made the error; and documented for quality assurance measurements for individual staff and departmental performance management. 8. Harbor generates and mails claim checks, along with explanations of benefits (remittance advice) to Providers biweekly. C. Provider Payments: Primary Care Physician 1. Harbor contracts Primary Care Physician s (PCP) under a capitation model of a set dollar amount per member per month (PMPM); or under a fee-for-service (FFS) model. a. PCP s contracted under the capitation agreement are reimbursed a set dollar amount PMPM for all services rendered to assigned patients except for Pay for Performance services, which are paid an incentive payment on a quarterly basis for specific CPT/HCPCS codes. b. PCP s contracted under the FFS model are reimbursed the Medicaid Fee Schedule published at the time the claim is processed for all covered services, and an additional incentive payment for Pay for Performance services rendered to assigned patients on a quarterly basis. Page 6 of 10

7 Original Approval Date: 01/31/2006 Page 7 of 10 c. The fee-for-service model is most appropriate when Harbor membership is insufficient or financial viability is threatened for either the Practitioners/Providers or the Plan if operated under a capitation reimbursement model. d. All PCP s whether FFS or Capitated must submit encounter data to Harbor in a timely manner using the CMS-1500 claim form or electronic claim submission. D. Provider Payments: Specialty Providers/Medical Clinics 1. Contracted Specialty Providers are paid Fee-For-Service based on the Michigan Medicaid Fee Schedule published at the time the claim is processed, or a fee negotiated by Harbor for each individual claim submitted to Harbor. 2. Non-Contracted Specialty Providers are paid Fee-For-Service based on the Michigan Medicaid Fee Schedule published at the time the claim is processed for each individual claim submitted to Harbor. E. Provider Payments: Outpatient Hospital 1. Outpatient Hospital Services are reimbursed Fee-For-Service according to the Ambulatory Payment Classification (APC) - Outpatient Perspective Payment System (OPPS) methodology for each individual claim submitted to Harbor. 2. Harbor utilizes the Ingenix Web.Strat software application to price Outpatient hospital claim submissions. Harbor maintains a service agreement with Ingenix to ensure timely updates to the Web.Strat software. 3. Harbor may reimburse a flat rate to contracted providers for specific services as defined in the hospitals contract terms. F. Provider Payments: Inpatient Hospital Page 7 of 10

8 Original Approval Date: 01/31/2006 Page 8 of Harbor shall reimburse contracted and non-contracted inpatient hospital claims at 100% of the Medicaid DRG payment methodology for authorized inpatient admissions, unless otherwise stated in the provider s contract. 2. Harbor may reimburse contracted providers up to 110% of the Medicaid DRG payment methodology as defined in the hospital contract terms. 3. All inpatient hospital professional services will be reimbursed Fee-For- Service based on the Michigan Medicaid Fee Schedule published at the time the claim is processed. G. Payment Procedures 1. Harbor shall pay all clean claims for contracted and non-contracted providers within 45 days of receipt using the Medicaid Fee Schedule in effect on the date of service or other negotiated rate. 2. When Harbor has received the claim, it has 30 days from that date to identify in writing to the Practitioners/Providers any defects in the claim. a. If the claim is defective due to failure to comply with any of the established Medicaid clean claim requirements, the claim does not qualify as a clean claim and the 45 day payment timeline for clean claims no longer applies. b. Harbor shall notify the Practitioners/Providers of the claim defect either electronically or on paper. c. The Practitioners/Providers has 30 days from the date of receipt of the notice of defective claim to correct the defect and resubmit the corrected claim to Harbor. Page 8 of 10

9 Original Approval Date: 01/31/2006 Page 9 of 10 d. If the corrected claim that is returned to Harbor is still defective for the same or another reason, Harbor shall notify the Practitioners/Providers of the remaining defect within 30 days from the date Harbor receives the corrected claim. e. Harbor will also notify the Insurance Commissioner of the defect on the required form. 3. Upon receipt of any claim, if Harbor determines that one or more covered services listed on a claim are payable, Harbor will pay for those services and will not deny the entire claim because one or more services listed are in dispute or not covered. 4. The Practitioners/Providers must allow Harbor at least 30 days to provide notice of any reason for not paying the claim. If a nonpayment notice has not been sent within 30 days, the Practitioners/Providers may assume payment will be made within 45 days from the date of receipt by Harbor. If Practitioners/Providers resubmit a claim before the 45 days have elapsed, it will not be considered a clean claim. 5. If the claim or a service listed on a claim form becomes the subject of an adverse determination on payment, Harbor maintains a Claims Payment Appeals process which the Practitioners/Providers may utilize (see Harbor s Practitioner/Provider Complaints and Appeals Process). 6. Alternately, the Practitioner/Provider may: a. Request an external review by the Insurance Commissioner within 30 days after the Practitioner/Provider receives notice of the adverse determination; or b. Request arbitration of the dispute. Page 9 of 10

10 Original Approval Date: 01/31/2006 Page 10 of 10 V. MATERIALS i. If the Practitioner/Provider requests arbitration, Harbor shall participate with the Practitioner/Provider in a binding arbitration process pursuant to a model arbitration agreement developed by DCH. ii. The party found to be at fault will be assessed the costs of the arbitrator. iii. If both parties are at fault, the cost of the arbitrator will be apportioned. iv. However, Practitioners/Provider may only choose either an external review by the Insurance Commissioner or arbitration, not both. 1. Claims and Encounter Data Process Flow Chart 2. Pre-Pay Out Audit Process Tool 3. DCH Model Arbitration Agreement 4. Harbor Provider Manual 5. OFIR Forms ( Defective Claim Notification ; Request for OFIR External Review ) VI. REPORTING/RECORDS 1. MDCH Monthly Claims Report 2. Pre Pay Out Edit Listing Report Page 10 of 10

TABLE OF CONTENTS. Claims Processing & Provider Compensation

TABLE OF CONTENTS. Claims Processing & Provider Compensation TABLE OF CONTENTS Claims Address... 2 Claim Submission... 2 Claim Payment... 2 Claim Payment Adjustments.... 2 Claim Disputes... 2 Recovery of Overpayments... 3 Balance Billing... 3 Annual Health Assessment

More information

Molina Healthcare of Ohio, Inc. PO Box 22712 Long Beach, CA 90801

Molina Healthcare of Ohio, Inc. PO Box 22712 Long Beach, CA 90801 Section 9. Claims As a contracted provider, it is important to understand how the claims process works to avoid delays in processing your claims. The following items are covered in this section for your

More information

Section 9. Claims Claim Submission Molina Healthcare PO Box 22815 Long Beach, CA 90801

Section 9. Claims Claim Submission Molina Healthcare PO Box 22815 Long Beach, CA 90801 Section 9. Claims As a contracted provider, it is important to understand how the claims process works to avoid delays in processing your claims. The following items are covered in this section for your

More information

Molina Healthcare of Washington, Inc. CLAIMS

Molina Healthcare of Washington, Inc. CLAIMS CLAIMS As a contracted provider, it is important to understand how the claims process works to avoid delays in processing your claims. The following items are covered in this section for your reference:

More information

Premera Blue Cross Medicare Advantage Provider Reference Manual

Premera Blue Cross Medicare Advantage Provider Reference Manual Premera Blue Cross Medicare Advantage Provider Reference Manual Introduction to Premera Blue Cross Medicare Advantage Plans Premera Blue Cross offers Medicare Advantage (MA) plans in King, Pierce, Snohomish,

More information

AETNA MEDICARE OPEN SM PLAN PROVIDER TERMS AND CONDITIONS OF PAYMENT

AETNA MEDICARE OPEN SM PLAN PROVIDER TERMS AND CONDITIONS OF PAYMENT AETNA MEDICARE OPEN SM PLAN PROVIDER TERMS AND CONDITIONS OF PAYMENT Table of Contents 1. Introduction 2. When a provider is deemed to accept Aetna Medicare Open Plan s terms and conditions 3. Provider

More information

Revenue Cycle Responsibilities. Revenue Cycle. Objectives 4/9/2013

Revenue Cycle Responsibilities. Revenue Cycle. Objectives 4/9/2013 Revenue Cycle Kathryn DeVault, RHIA, CCS, CCS-P AHIMA 2013 Objectives Identify responsibilities within the Revenue Cycle Focus on management of the revenue cycle process Discuss the revenue cycle process

More information

Final. National Health Care Billing Audit Guidelines. as amended by. The American Association of Medical Audit Specialists (AAMAS)

Final. National Health Care Billing Audit Guidelines. as amended by. The American Association of Medical Audit Specialists (AAMAS) Final National Health Care Billing Audit Guidelines as amended by The American Association of Medical Audit Specialists (AAMAS) May 1, 2009 Preface Billing audits serve as a check and balance to help ensure

More information

SECTION 4. A. Balance Billing Policies. B. Claim Form

SECTION 4. A. Balance Billing Policies. B. Claim Form SECTION 4 Participating Physicians, hospitals and ancillary providers shall be entitled to payment for covered services that are provided to a DMC Care member. Payment is made at the established and prevailing

More information

Physician, Health Care Professional, Facility and Ancillary Provider Administrative Guide for American Medical Security Life Insurance Company

Physician, Health Care Professional, Facility and Ancillary Provider Administrative Guide for American Medical Security Life Insurance Company Physician, Health Care Professional, Facility and Ancillary Provider Administrative Guide for American Medical Security Life Insurance Company Insureds 2009 Contents How to contact us... 2 Our claims process...

More information

CODING. Neighborhood Health Plan 1 Provider Payment Guidelines

CODING. Neighborhood Health Plan 1 Provider Payment Guidelines CODING Policy The terms of this policy set forth the guidelines for reporting the provision of care rendered by NHP participating providers, including but not limited to use of standard diagnosis and procedure

More information

Molina Healthcare of Puerto Rico (MHPR) Non-Participating Provider Information

Molina Healthcare of Puerto Rico (MHPR) Non-Participating Provider Information Molina Healthcare of Puerto Rico (MHPR) Non-Participating Provider Information Please refer to Carta Normativa 15-0326 Re Transicion for details regarding the ASES-established Transition of Care and Reimbursement

More information

AB1455 Claims Processing Complete Definitions

AB1455 Claims Processing Complete Definitions Complete s Automatically Automatically means the payment of the interest due to the provider within five (5) working days of the payment of the claim without the need for any reminder or : (a) (1) request

More information

Compensation and Claims Processing

Compensation and Claims Processing Compensation and Claims Processing Compensation The network rate for eligible outpatient visits is reimbursed to you at the lesser of (1) your customary charge, less any applicable co-payments, coinsurance

More information

Treatment Facilities Amended Date: October 1, 2015. Table of Contents

Treatment Facilities Amended Date: October 1, 2015. Table of Contents Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 1.1 Definitions... 1 2.0 Eligibility Requirements... 1 2.1 Provisions... 1 2.1.1 General... 1 2.1.2 Specific... 1 2.2 Special

More information

SUBCHAPTER 10F ELECTRONIC BILLING RULES SECTION.0100 ADMINISTRATION

SUBCHAPTER 10F ELECTRONIC BILLING RULES SECTION.0100 ADMINISTRATION SUBCHAPTER 10F ELECTRONIC BILLING RULES SECTION.0100 ADMINISTRATION 04 NCAC 10F.0101 ELECTRONIC MEDICAL BILLING AND PAYMENT REQUIREMENT Carriers and licensed health care providers shall utilize electronic

More information

MEDICARE ADVANTAGE PRIVATE FEE FOR SERVICE (PFFS) PLAN 2009 TERMS AND CONDITIONS OF PAYMENT. Table of Contents

MEDICARE ADVANTAGE PRIVATE FEE FOR SERVICE (PFFS) PLAN 2009 TERMS AND CONDITIONS OF PAYMENT. Table of Contents MEDICARE ADVANTAGE PRIVATE FEE FOR SERVICE (PFFS) PLAN 2009 TERMS AND CONDITIONS OF PAYMENT 1. Introduction Table of Contents 2. When a provider is deemed to accept Blue Cross of Idaho Flexi Blue PFFS

More information

The benefits of electronic claims submission improve practice efficiencies

The benefits of electronic claims submission improve practice efficiencies The benefits of electronic claims submission improve practice efficiencies Electronic claims submission vs. manual claims submission An electronic claim is a paperless patient claim form generated by computer

More information

Medi-Pak Advantage: Frequently Asked Questions

Medi-Pak Advantage: Frequently Asked Questions Medi-Pak Advantage: Frequently Asked Questions General Information: What Medicare Advantage product is Arkansas Blue Cross Blue Shield offering? Arkansas Blue Cross and Blue Shield has been approved by

More information

MEDICAL CLAIMS AND ENCOUNTER PROCESSING

MEDICAL CLAIMS AND ENCOUNTER PROCESSING MEDICAL CLAIMS AND ENCOUNTER PROCESSING February, 2014 John Williford Senior Director Health Plan Operations 2 Medical Claims and Encounter Processing Medical claims and encounter processing is part of

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

RULES AND REGULATIONS FOR UTILIZATION REVIEW IN ARKANSAS ARKANSAS DEPARTMENT OF HEALTH

RULES AND REGULATIONS FOR UTILIZATION REVIEW IN ARKANSAS ARKANSAS DEPARTMENT OF HEALTH RULES AND REGULATIONS FOR UTILIZATION REVIEW IN ARKANSAS 2003 ARKANSAS DEPARTMENT OF HEALTH TABLE OF CONTENTS SECTION 1 Authority and Purpose.. 1 SECTION 2 Definitions...2 SECTION 3 Private Review Agents

More information

Exhibit 2.9 Utilization Management Program

Exhibit 2.9 Utilization Management Program Exhibit 2.9 Utilization Management Program Access HealthSource, Inc. Utilization Management Company is licensed as a Utilization Review Agent with the Texas Department of Insurance. The Access HealthSource,

More information

Compensation and Claims Processing

Compensation and Claims Processing Compensation and Claims Processing Compensation The network rate for eligible outpatient visits is reimbursed to you at the lesser of (1) your customary charge, less any applicable co-payments, coinsurance

More information

Psychiatric Rehabilitation Clinical Coverage Policy No: 8D-1 Treatment Facilities Revised Date: August 1, 2012. Table of Contents

Psychiatric Rehabilitation Clinical Coverage Policy No: 8D-1 Treatment Facilities Revised Date: August 1, 2012. Table of Contents Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 2.0 Eligible Recipients... 1 2.1 Provisions... 1 2.2 EPSDT Special Provision: Exception to Policy Limitations for Recipients

More information

! Claims and Billing Guidelines

! Claims and Billing Guidelines ! Claims and Billing Guidelines Electronic Claims Clearinghouses and Vendors 16.1 Electronic Billing 16.2 Institutional Claims and Billing Guidelines 16.3 Professional Claims and Billing Guidelines 16.4

More information

MEDICAL MANAGEMENT OVERVIEW MEDICAL NECESSITY CRITERIA RESPONSIBILITY FOR UTILIZATION REVIEWS MEDICAL DIRECTOR AVAILABILITY

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

More information

Section 6. Medical Management Program

Section 6. Medical Management Program Section 6. Medical Management Program Introduction Molina Healthcare maintains a medical management program to ensure patient safety as well as detect and prevent fraud, waste and abuse in its programs.

More information

Instructions for submitting Claim Reconsideration Requests

Instructions for submitting Claim Reconsideration Requests Instructions for submitting Claim Reconsideration Requests A Claim Reconsideration Request is typically the quickest way to address any concern you have with how we processed your claim. With a Claim Reconsideration

More information

Overview of Hospital Utilization Review

Overview of Hospital Utilization Review Overview of Hospital Utilization Review Legal Authority The Inspector General (IG) hospital utilization review function operates under guidelines and regulations contained in: Texas Administrative Code

More information

To submit electronic claims, use the HIPAA 837 Institutional transaction

To submit electronic claims, use the HIPAA 837 Institutional transaction 3.1 Claim Billing 3.1.1 Which Claim Form to Use Claims that do not require attachments may be billed electronically using Provider Electronic Solutions (PES) software (provided by Electronic Data Systems

More information

Glossary of Insurance and Medical Billing Terms

Glossary of Insurance and Medical Billing Terms A Accept Assignment Provider has agreed to accept the insurance company allowed amount as full payment for the covered services. Adjudication The final determination of the issues involving settlement

More information

Handbook for Providers of Therapy Services

Handbook for Providers of Therapy Services Handbook for Providers of Therapy Services Chapter J-200 Policy and Procedures For Therapy Services Illinois Department of Healthcare and Family Services CHAPTER J-200 THERAPY SERVICES TABLE OF CONTENTS

More information

SECTION 7: APPEALS TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1

SECTION 7: APPEALS TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 SECTION 7: APPEALS 7.1 Appeal Methods................................................................. 7-2 7.1.1 Electronic Appeal Submission.......................................................

More information

Medicare Advantage Program. Michael Taylor, PhD Medicare Advantage Manager

Medicare Advantage Program. Michael Taylor, PhD Medicare Advantage Manager Medicare Advantage Program Michael Taylor, PhD Medicare Advantage Manager Objectives General Overview of Medicare Advantage CMS 5 Star Ratings Medicare Part C & D Audit Process Coping with Contract Terminations

More information

Glossary of Frequently Used Billing and Coding Terms

Glossary of Frequently Used Billing and Coding Terms Glossary of Frequently Used Billing and Coding Terms Accountable Care Organization (ACO) Accounts Receivable Reports All Inclusive Fees Allowances and Adjustments Capitation Payments Care Coordination

More information

Molina Healthcare of Washington, Inc. Glossary GLOSSARY OF TERMS

Molina Healthcare of Washington, Inc. Glossary GLOSSARY OF TERMS GLOSSARY OF TERMS Action The denial or limited Authorization of a requested service, including the type, level or provider of service; reduction, suspension, or termination of a previously authorized service;

More information

Title 40. Labor and Employment. Part 1. Workers' Compensation Administration

Title 40. Labor and Employment. Part 1. Workers' Compensation Administration Title 40 Labor and Employment Part 1. Workers' Compensation Administration Chapter 3. Electronic Billing 301. Purpose The purpose of this Rule is to provide a legal framework for electronic billing, processing,

More information

Medical and Rx Claims Procedures

Medical and Rx Claims Procedures This section of the Stryker Benefits Summary describes the procedures for filing a claim for medical and prescription drug benefits and how to appeal denied claims. Medical and Rx Benefits In-Network Providers

More information

NC WORKERS COMPENSATION: BASIC INFORMATION FOR MEDICAL PROVIDERS

NC WORKERS COMPENSATION: BASIC INFORMATION FOR MEDICAL PROVIDERS NC WORKERS COMPENSATION: BASIC INFORMATION FOR MEDICAL PROVIDERS CURRENT AS OF APRIL 1, 2010 I. INFORMATION SOURCES Where is information available for medical providers treating patients with injuries/conditions

More information

Chapter 7. Billing and Claims Processing

Chapter 7. Billing and Claims Processing Chapter 7. Billing and Claims Processing 7.1 Electronic Claims Submission 3 7.1.1 How it Works... 3 7.1.2 Advantages... 3 7.1.3 How to Initiate... 4 7.1.4 Transactions Available... 5 7.1.5 NAIC Codes...

More information

5557 FAQs & Definitions

5557 FAQs & Definitions 5557 FAQs & Definitions These Questions and Answers are intended to present information that has been acquired as part of the discovery process and provides necessary context for the Policy Directives

More information

Section 10. Compliance

Section 10. Compliance Section 10. Compliance Fraud, Waste, and Abuse Introduction Molina Healthcare of [state] maintains a comprehensive Fraud, Waste, and Abuse program. The program is held accountable for the special investigative

More information

Title: Coding Documentation for IHS Affiliated Physician Practices

Title: Coding Documentation for IHS Affiliated Physician Practices Affiliated Physician Practices Effective Date: 11/03; Rev. 4/06, 7/08, 7/10 POLICY: IHS affiliated physician practices will code diagnoses utilizing the International Classification of Diseases, Ninth

More information

Frequently Asked Questions About Your Hospital Bills

Frequently Asked Questions About Your Hospital Bills Frequently Asked Questions About Your Hospital Bills The Registration Process Why do I have to verify my address each time? Though address and telephone numbers remain constant for approximately 70% of

More information

MEDICAL ASSISTANCE BULLETIN

MEDICAL ASSISTANCE BULLETIN ISSUE DATE April 8, 2011 EFFECTIVE DATE April 8, 2011 MEDICAL ASSISTANCE BULLETIN NUMBER 03-11-01, 09-11-02, 14-11-01, 18-11-01 24-11-03, 27-11-02, 31-11-02, 33-11-02 SUBJECT Electronic Prescribing Internet-based

More information

[Document Identifier: CMS-10003, CMS-10467, CMS-1450(UB-04), CMS-1500(08-05)]

[Document Identifier: CMS-10003, CMS-10467, CMS-1450(UB-04), CMS-1500(08-05)] This document is scheduled to be published in the Federal Register on 10/16/2015 and available online at http://federalregister.gov/a/2015-26390, and on FDsys.gov DEPARTMENT OF HEALTH AND HUMAN SERVICES

More information

Minimum Performance and Service Criteria for Medicare Part D

Minimum Performance and Service Criteria for Medicare Part D Minimum Performance and Service Criteria for Medicare Part D 1. Terms and Conditions. In addition to the other terms and conditions of the Pharmacy Participation Agreement ( Agreement ), the following

More information

Section Eleven. Referrals and Pre-Authorization REFERRAL PROCESS

Section Eleven. Referrals and Pre-Authorization REFERRAL PROCESS REFERRAL PROCESS Physician Referrals within Plan Network Physicians may refer members to any Specialty Care Physician (Specialist) or ancillary provider within the Fidelis Care network. Except as noted

More information

Administrative Code. Title 23: Medicaid Part 306 Third Party Recovery

Administrative Code. Title 23: Medicaid Part 306 Third Party Recovery Administrative Code Title 23: Medicaid Part 306 Third Party Recovery Table of Contents Title 23: Division of Medicaid... 1 Part 306: Third Party Recovery... 1 Part 306 Chapter 1: Third Party Recovery...

More information

PROVIDER MANUAL Page 1 of 12 Last Revised December 2008

PROVIDER MANUAL Page 1 of 12 Last Revised December 2008 Page 1 of 12 Last Revised December 2008 Table of Contents Introduction 3 General Information 4 Who Do I Call?.5 ID Card Logo.6 Credentialing.7 Provider Changes..8 Referral and Authorization.9 Claims Payment

More information

Qtr 2. 2011 Provider Update Bulletin

Qtr 2. 2011 Provider Update Bulletin West Virginia Medicaid WEST VIRGINIA Department of Health & Human Resources Qtr 2. 2011 Provider Update Bulletin West Virginia Medicaid Provider Update Bulletin Qtr. 2, 2011 Volume 1 Inside This Issue:

More information

ICD-10 Compliance Date

ICD-10 Compliance Date ICD-10 Implementation Frequently Asked Questions Updated September 2015 ICD-10 Compliance Date The U.S. Department of Health and Human Services (HHS) issued a rule on July 31, 2014 finalizing October 1,

More information

[ 1 Small Business Health Options Program Exchange (SHOP Exchange)] Group Policy UnitedHealthcare Insurance Company

[ 1 Small Business Health Options Program Exchange (SHOP Exchange)] Group Policy UnitedHealthcare Insurance Company [ 1 Applies to SHOP Plans] [ 1 Small Business Health Options Program Exchange (SHOP Exchange)] Group Policy UnitedHealthcare Insurance Company [185 Asylum Street] [Hartford, Connecticut 06103-3408] [1-800-357-1371]

More information

Your Revenue Cycle It s not just billing anymore. Presented by: Candy Edie, MBA, CRCE-I

Your Revenue Cycle It s not just billing anymore. Presented by: Candy Edie, MBA, CRCE-I Your Revenue Cycle It s not just billing anymore Presented by: Candy Edie, MBA, CRCE-I POSITIONS Staff Accountant Chief Financial Officer Financial Systems Analyst Patient Access Director Patient Financial

More information

NEW YORK STATE MEDICAID PROGRAM MANAGED CARE MANUAL: STOP-LOSS POLICY AND PROCEDURE

NEW YORK STATE MEDICAID PROGRAM MANAGED CARE MANUAL: STOP-LOSS POLICY AND PROCEDURE NEW YORK STATE MEDICAID PROGRAM MANAGED CARE MANUAL: STOP-LOSS POLICY AND PROCEDURE Version 2011 1 (01/31/11) Page 1 of 23 TABLE OF CONTENTS Section I Purpose Statement... 3 Section II Stop-loss Policy

More information

Health Resources Division Rule Changes (Effective 7/1/14)

Health Resources Division Rule Changes (Effective 7/1/14) Health Resources Division Rule Changes (Effective 7/1/14) Health Resources Division Mega Rule: ARM 37.85.105 The department is amending ARM 37.85.105 to reflect a 2% increase in Medicaid fees to providers.

More information

8.310.12.1 ISSUING AGENCY: New Mexico Human Services Department (HSD). [8.310.12.1 NMAC - N, 11-1-14]

8.310.12.1 ISSUING AGENCY: New Mexico Human Services Department (HSD). [8.310.12.1 NMAC - N, 11-1-14] TITLE 8 SOCIAL SERVICES CHAPTER 310 HEALTH CARE PROFESSIONAL SERVICES PART 12 INDIAN HEALTH SERVICE AND TRIBAL 638 FACILITIES 8.310.12.1 ISSUING AGENCY: New Mexico Human Services Department (HSD). [8.310.12.1

More information

Medicaid Purchasing Administration (MPA) Diabetes Education Program Billing Instructions. ProviderOne Readiness Edition

Medicaid Purchasing Administration (MPA) Diabetes Education Program Billing Instructions. ProviderOne Readiness Edition Medicaid Purchasing Administration (MPA) Diabetes Education Program Billing Instructions ProviderOne Readiness Edition About This Publication This publication supersedes all previous Department/MPA Diabetes

More information

West Virginia Reimbursement Policies Table of Contents

West Virginia Reimbursement Policies Table of Contents UniCare Health Plan of West Virginia, Inc. Medicaid Managed Care Administration Claims Requiring Additional Documentation 4 Claims Submission - Required Information for Facilities 7 Claims Submission -

More information

Please follow these suggestions in order to facilitate timely reimbursement of claims and to avoid timely filing issues:

Please follow these suggestions in order to facilitate timely reimbursement of claims and to avoid timely filing issues: Claims/Payment Section K-1 New Claims Submissions All claims must be submitted and received by Molina Healthcare of New Mexico, Inc. (Molina Healthcare) within ninety (90) days from the date of service

More information

2006 Provider Coding/Billing Information. www.novoseven-us.com

2006 Provider Coding/Billing Information. www.novoseven-us.com 2006 Provider Coding/Billing Information 2 3 Contents About NovoSeven...2 Coverage...4 Coding...4 Reimbursement...8 Establishing Medical Necessity and Appealing Denied Claims...10 Claims Materials...12

More information

PROSPECT MEDICAL GROUP DOWNSTREAM PROVIDER NOTICE CLAIMS SETTLEMENT PRACTICES AND DISPUTE RESOLUTION MECHANISM

PROSPECT MEDICAL GROUP DOWNSTREAM PROVIDER NOTICE CLAIMS SETTLEMENT PRACTICES AND DISPUTE RESOLUTION MECHANISM PROSPECT MEDICAL GROUP DOWNSTREAM PROVIDER NOTICE CLAIMS SETTLEMENT PRACTICES AND DISPUTE RESOLUTION MECHANISM As required by Assembly Bill 1455, the California Department of Managed Health Care has set

More information

Surgical/ASC Claims Revenue Cycle Management: An Introduction to Our Processes and Protocols

Surgical/ASC Claims Revenue Cycle Management: An Introduction to Our Processes and Protocols Surgical/ASC Claims Revenue Cycle Management: An Introduction to Our Processes and Protocols 200 Old Country Road, Suite 470 Mineola, NY 11501 Phone: 516-294-4118 Fax: 516-294-9268 www.businessdynamicslimited.com

More information

Understanding the HIPAA standard transactions: The HIPAA Transactions and Code Set rule

Understanding the HIPAA standard transactions: The HIPAA Transactions and Code Set rule Understanding the HIPAA standard transactions: The HIPAA Transactions and Code Set rule Many physician practices recognize the Health Information Portability and Accountability Act (HIPAA) as both a patient

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

HANDBOOK FOR ADVANCED PRACTICE NURSES

HANDBOOK FOR ADVANCED PRACTICE NURSES HANDBOOK FOR ADVANCED PRACTICE NURSES CHAPTER N 200 Policy and Procedures for Advanced Practice Nurse Services Illinois Department of Public Aid FOREWORD PURPOSE CHAPTER N-200 ADVANCED PRACTICE NURSE SERVICES

More information

Regulatory Compliance Policy No. COMP.RCC 4.70 Title:

Regulatory Compliance Policy No. COMP.RCC 4.70 Title: I. SCOPE: Regulatory Compliance Policy No. COMP.RCC 4.70 Page: 1 of 9 This policy applies to (1) Tenet Healthcare Corporation and its wholly-owned subsidiaries and affiliates (each, an Affiliate ); (2)

More information

2013 Biller B Aware. The survey link and instructions have been posted at www.michigan.gov/5010icd10/ >> ICD-10 Information >> Testing.

2013 Biller B Aware. The survey link and instructions have been posted at www.michigan.gov/5010icd10/ >> ICD-10 Information >> Testing. 2013 Biller B Aware December 30, 2013: Attention ALL Providers: Due to a CHAMPS system issue, the Remittance Advice (RA) and 835 files for Pay Cycle 52 dated 12/26/2013 may not balance. MDCH will recreate

More information

Credentialing/Recredentialing

Credentialing/Recredentialing Credentialing/Recredentialing Section F-1 Credentialing Practitioner Credentialing Molina Healthcare of New Mexico, Inc. (Molina Healthcare) credentials practitioners/providers in accordance with internal

More information

Billing and Claim Billing and Claim Submission Boot Camp Submission Boot Camp Beverly Remm Beverly Remm

Billing and Claim Billing and Claim Submission Boot Camp Submission Boot Camp Beverly Remm Beverly Remm Billing and Claim Submission Boot Camp Presented by: Beverly Remm Orion Healthcare Technology Billing and Claim Submission Boot Camp Presented by: Beverly Remm Orion Healthcare Technology The presentation

More information

REIMBURSEMENT OVERVIEW WEB TOOLS AND RESOURCES HIPAA REQUIREMENTS FOR ELECTRONIC TRANSACTIONS

REIMBURSEMENT OVERVIEW WEB TOOLS AND RESOURCES HIPAA REQUIREMENTS FOR ELECTRONIC TRANSACTIONS 3 CLAIMS, BILLING & REIMBURSEMENT OVERVIEW All claims must be submitted in accordance with the requirements of the provider contract, applicable member s contract, and this Sourcebook. You may not seek

More information

Title 19, Part 3, Chapter 14: Managed Care Plan Network Adequacy. Requirements for Health Carriers and Participating Providers

Title 19, Part 3, Chapter 14: Managed Care Plan Network Adequacy. Requirements for Health Carriers and Participating Providers Title 19, Part 3, Chapter 14: Managed Care Plan Network Adequacy Table of Contents Rule 14.01. Rule 14.02. Rule 14.03. Rule 14.04. Rule 14.05. Rule 14.06. Rule 14.07. Rule 14.08. Rule 14.09. Rule 14.10.

More information

Government Programs Provider Manual

Government Programs Provider Manual Government Programs Provider Manual July 2013 Website: www.childrenshealthplan.com Email:providerinfo@childrens.com Provider Services: 214-456-2765 Dallas Service Area Table of Contents I. I. Introduction

More information

Provider Revenue Cycle Management (RCM) and Proposed Solutions

Provider Revenue Cycle Management (RCM) and Proposed Solutions Provider Revenue Cycle Management (RCM) and Proposed Solutions By: Ranjana Maitra General Manager, Manufacturing & Healthcare Vertical Executive Summary It takes more than world-class service to be competitive

More information

MICHIGAN REGULATORY REQUIREMENTS MANUAL

MICHIGAN REGULATORY REQUIREMENTS MANUAL MICHIGAN REGULATORY REQUIREMENTS MANUAL Meridian Health Plan of Michigan ( Plan ) contracts with various network providers, hospitals, ancillary providers, specialists and other practitioners ( You or

More information

Transition to ICD-10: Frequently Asked Questions

Transition to ICD-10: Frequently Asked Questions This reference document was developed to answer provider questions about the mandated transition to the ICD-10 code sets. It will be updated as additional information becomes available. We encourage you

More information

SECTION G BILLING AND CLAIMS

SECTION G BILLING AND CLAIMS CLAIMS PAYMENT METHODS SECTION G Harbor Advantage (HMO) offers 2 forms of payment for services provided; paper check and electronic funds transfer (direct deposit). Electronic Funds Transfer (EFT) Harbor

More information

Wyoming. Eligible Professional Meaningful Use Modified Stage 2 User Manual for Program Year 2015. April 2015 Version 1

Wyoming. Eligible Professional Meaningful Use Modified Stage 2 User Manual for Program Year 2015. April 2015 Version 1 Wyoming Eligible Professional Meaningful Use Modified Stage 2 User Manual for Program Year 2015 April 2015 Version 1 Table of Contents 1 Background... 1 2 Introduction... 2 3 Eligibility... 3 3.1 Out-of-State

More information

Duplicate Claims Verify claims receipt with BCBSNM prior to resubmitting to prevent denials.

Duplicate Claims Verify claims receipt with BCBSNM prior to resubmitting to prevent denials. Claims Submission Electronically : Use Payer ID 00790 For information on electronic filing of claims, contact Availity at 1-800-282-4548. Paper claims must be submitted on the Standard CMS-1500 (Physician/Professional

More information

Reimbursement Guide 2011

Reimbursement Guide 2011 Reimbursement Guide 2011 IMPORTANT SAFETY INFORMATION HYALGAN is indicated for the treatment of pain in osteoarthritis (OA) of the knee in patients who have failed to respond adequately to conservative

More information

Hospice care services

Hospice care services Hospice care services Summary of change: Effective February 1, 2015, hospice services will be a covered benefit covered by Amerigroup Louisiana, Inc. Amerigroup Louisiana, Inc. recognizes the importance

More information

COM Compliance Policy No. 3

COM Compliance Policy No. 3 COM Compliance Policy No. 3 THE UNIVERSITY OF ILLINOIS AT CHICAGO NO.: 3 UIC College of Medicine DATE: 8/5/10 Chicago, Illinois PAGE: 1of 7 UNIVERSITY OF ILLINOIS COLLEGE OF MEDICINE CODING AND DOCUMENTATION

More information

LEGISLATURE OF THE STATE OF IDAHO Sixtieth Legislature First Regular Session 2009 IN THE HOUSE OF REPRESENTATIVES HOUSE BILL NO.

LEGISLATURE OF THE STATE OF IDAHO Sixtieth Legislature First Regular Session 2009 IN THE HOUSE OF REPRESENTATIVES HOUSE BILL NO. LEGISLATURE OF THE STATE OF IDAHO Sixtieth Legislature First Regular Session 0 IN THE HOUSE OF REPRESENTATIVES HOUSE BILL NO. BY BUSINESS COMMITTEE 0 AN ACT RELATING TO HEALTH INSURANCE; AMENDING TITLE,

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

CLAIMS Section 5. Overview. Clean Claim. Prompt Payment. Timely Claims Submission. Claim Submission Format

CLAIMS Section 5. Overview. Clean Claim. Prompt Payment. Timely Claims Submission. Claim Submission Format Overview The Claims department partners with the Provider Relations, Health Services and Customer Service departments to assist providers with any claims-related questions. The focus of the Claims department

More information

Claims Procedures. H.2 At a Glance. H.4 Submission Guidelines. H.9 Claims Documentation. H.17 Codes and Modifiers. H.

Claims Procedures. H.2 At a Glance. H.4 Submission Guidelines. H.9 Claims Documentation. H.17 Codes and Modifiers. H. H.2 At a Glance H.4 Submission Guidelines H.9 Claims Documentation H.17 Codes and Modifiers H.22 Reimbursement H.25 Denials and Appeals At a Glance pledges to provide accurate and efficient claims processing.

More information

Appeals Provider Manual 15

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...

More information

NOVOSTE BETA-CATH SYSTEM

NOVOSTE BETA-CATH SYSTEM HOSPITAL INPATIENT AND OUTPATIENT BILLING GUIDE FOR THE NOVOSTE BETA-CATH SYSTEM INTRAVASCULAR BRACHYTHERAPY DEVICE This guide is intended solely for use as a tool to help hospital billing staff resolve

More information

1500 Claims Processing Manual DHMP Health Insurance Claim Form CMS-1500

1500 Claims Processing Manual DHMP Health Insurance Claim Form CMS-1500 DENVER HEALTH MEDICAL PLAN, INC. 1500 Claims Processing Manual DHMP Health Insurance Claim Form CMS-1500 Box 1 Medicare, Medicaid, Group Health Plan or other insurance Information Show the type of health

More information

PHASE II CORE 260 ELIGIBILITY & BENEFITS (270/271) DATA CONTENT RULE VERSION 2.1.0 SECTION 6.2 APPENDIX 2: GLOSSARY OF DATA CONTENT TERMS MARCH 2011

PHASE II CORE 260 ELIGIBILITY & BENEFITS (270/271) DATA CONTENT RULE VERSION 2.1.0 SECTION 6.2 APPENDIX 2: GLOSSARY OF DATA CONTENT TERMS MARCH 2011 PHASE II CORE 260 ELIGIBILITY & BENEFITS (270/271) DATA CONTENT RULE VERSION 2.1.0 SECTION 6.2 APPENDIX 2: GLOSSARY OF DATA CONTENT TERMS MARCH 2011 CAQH 2008-2011. All rights reserved. 1 Table of Contents

More information

Riverside Physician Network Utilization Management

Riverside Physician Network Utilization Management Subject: Program Riverside Physician Network Author: Candis Kliewer, RN Department: Product: Commercial, Senior Revised by: Linda McKevitt, RN Approved by: Effective Date January 1997 Revision Date 1/21/15

More information

Network Provider. Clinical Nurse Specialist. Contract

Network Provider. Clinical Nurse Specialist. Contract Network Provider Clinical Nurse Specialist Contract Updated 11/13/15 HCCNSv1.9 TABLE OF CONTENTS I. RECITALS... 1 II. DEFINITIONS.. 1 III. RELATIONSHIP BETWEEN EGID AND THE CLINICAL NURSE SPECIALIST...

More information

Network Provider Physician Assistant Contract

Network Provider Physician Assistant Contract Network Provider Physician Assistant Contract 11/13/15 HCPACv1.7 TABLE OF CONTENTS I. RECITALS... 1 II. DEFINITIONS. 1 III. RELATIONSHIP BETWEEN EGID AND THE PHYSICIAN ASSISTANT. 3 IV. PHYSICIAN ASSISTANT

More information

HIPAA: AN OVERVIEW September 2013

HIPAA: AN OVERVIEW September 2013 HIPAA: AN OVERVIEW September 2013 Introduction The Health Insurance Portability and Accountability Act of 1996, known as HIPAA, was enacted on August 21, 1996. The overall goal was to simplify and streamline

More information

Finally... maybe? The Long Awaited 340B Mega Guidance. Georgia Healthcare Financial Management Association. October 2015

Finally... maybe? The Long Awaited 340B Mega Guidance. Georgia Healthcare Financial Management Association. October 2015 Finally... maybe? The Long Awaited 340B Mega Guidance Georgia Healthcare Financial Management Association October 2015 Disclaimer This webinar assumes the participant is familiar with the basic operations

More information

Risk Adjustment ABC s

Risk Adjustment ABC s Medicare Advantage Risk Adjustment and Coding Academy Coding Risk Adjustment Documentation Training Risk Adjustment ABC s What is Risk Adjustment? Risk adjustment is the process by which the Medicare &

More information

Section D. Benefit Plans. #3. Section E. Claims Processing 2. C. n. Section E. Claims Processing 2. n. Section E. Claims Processing 2. o.

Section D. Benefit Plans. #3. Section E. Claims Processing 2. C. n. Section E. Claims Processing 2. n. Section E. Claims Processing 2. o. Questions for HPMS: Medical Claims TPA Question Section D. Benefit Section Plans. of RFP #3 Response 1. Please describe the types of benefit changes HPMS makes 1. Please into the describe current claim

More information

Network Provider. Nurse Practitioner. Contract

Network Provider. Nurse Practitioner. Contract Network Provider Nurse Practitioner Contract Updated 06-30-15 HCNPCv1.7 TABLE OF CONTENTS I. RECITALS... 1 II. DEFINITIONS. 1 III. RELATIONSHIP BETWEEN EGID AND THE NURSE PRACTITIONER.... 3 IV. NURSE PRACTITIONER

More information

Your Health Care Benefit Program. BlueChoice Certificate of Benefits

Your Health Care Benefit Program. BlueChoice Certificate of Benefits YourHealthCareBenefitProgram BlueChoice Certificate of Benefits 1400 South Boston P.O. Box 3283 Tulsa, Oklahoma 74102-3283 600600.0114 Effective January 1, 2014 Table of Contents Certificate... 1 Important

More information