Chapter 2 Provider Responsibilities Unit 4: PCP Policies and Procedures For All Products

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Chapter 2 Provider Responsibilities Unit 4: PCP Policies and Procedures For All Products"

Transcription

1 Chapter 2 Provider Responsibilities Unit 4: PCP Policies and Procedures For All Products In This Unit Topic See Page Unit 3: PCP Policies And Procedures For All Products Arranging for PCP Absence 2 Locum Tenens Policy 4 Requesting a Contract Copy 5 Member Removal Policy (Western Region Only) 6 Member Removal Procedure (Western Region Only) 9 How to Close and Re-open Your Practice To Members 11 Eligibility Rosters 12 How to Read the Eligibility Roster 13

2 2.4 Arranging For PCP Absence Introduction The purpose of this section is to explain what the PCP needs to do before leaving for vacation or other time off. Making The Necessary Arrangements 1. Find a PCP who participates in the same network(s) as you to provide medical treatment to members during your absence. 2. Resolve payment arrangements, including co-payments 3. Inform office staff of the above arrangements and ask that the covering physician inform his or her office staff of the arrangements. 4. Be sure that your answering service informs patients of the arrangement. Appointments Most members will be able to wait for their regular PCP s return. However, there will be some cases when a member will require an office visit during his or her PCP s absence. For such cases, the covering PCP s office staff should make an appointment or arrangements and give the member clear directions. Important: Authorization Requests During The PCP s Absence If the PCP is planning to be away for a short duration (less than 5 days), the covering PCP can request authorizations, and advise members to go to specialists or the emergency room during the PCP s absence. The covering physician may keep a list of these incidents, which he or she then shares when the member s PCP returns. For the treatment that took place during the absence, the member s PCP should submit any authorization requests expediently to avoid payment delays. Continued on next page 2

3 2.4 Arranging For PCP Absence Continued Reimbursement And Copayments We advise physicians to work out their own payment arrangements prior to covering for one another. We do not provide additional reimbursement to practitioners who are covering for other PCPs. The collection of co-payments works the same way. The two physicians involved should come to an agreement as to how this will be handled. Informing The Office Staff It is imperative that both the regular and the covering physicians office staffs be aware of any temporary coverage arrangements. Failing to notify the office staffs may decrease continuity of care to network members. 3

4 2.4 Locum Tenens Policy Overview Highmark allows providers with established assignment accounts to utilize the services of a locum tenens to cover for a credentialed provider of the group or provide additional coverage for increased demands or cover while recruiting additional providers. Rules To Utilize Locum Tenens In order for a provider to obtain this type of coverage the locum tenens: must be licensed to provide services in Pennsylvania can only provide services for a total of six months or less within any 12-month period beginning with the first date of active service. Procedure Step Action 1 Practice must notify their Provider Relations Representative (PRR) of their request for locum tenens. 2 The PRR must obtain the following information from the provider: A Participating Provider Agreement with Highmark Blue Shield form signed by the locum tenens (if they do not currently have a valid individual Highmark provider number or are currently nonparticipating). A Request for Addition/Deletion to Existing Assignment Account form signed by the locum tenens assigning payment for their services. The Locum Tenens form, available on the Provider Resource Center under Provider Forms, completed by the practice indicating, if applicable, who the locum tenens is covering for and the specific dates they will be providing services The Locum Tenens UPIN, Medicare welcome letter and NPI number if the group provides services to Medicare Advantage members. 3 The PRR will verify that the Locum Tenens was added to the assignment account and has not provided or will provide services in a time frame not to exceed 6 months. The PRR will notify applicable Highmark internal departments. 4 The PRR will notify the Assignment Account of the start and end dates of the locum tenens or of the reason the Locum Tenens cannot be added and notify the requesting provider. 4

5 2.4 Requesting A Contract Copy Overview Highmark allows participating providers to request copies of their participating physician contract, as required. Highmark will provide a copy of the contract with participating physicians including certain contracts with physician organizations or physician groups where participating physicians participate. Highmark is restricted, however, to provide contracts to requesters if the terms of the contract restrict the request. If you have further questions about this process, please contact your Provider Relations Representative. How To Request A Copy/Track The Status Of Your Participating Physician Contract Providers must direct a written request for a copy of their contract to: Highmark Blue Shield Provider Information Management P.O. Box Camp Hill, PA Upon receipt of the request, Highmark s Provider Maintenance department will provide the requestor one copy of their participating physician contract, unless otherwise requested. To check the status of your request, please call , option 4. Requests generally take 15 business days to process. Please allow ample time for processing before checking the request status. 5

6 2.4 Member Removal Policy Western Region Only Policy All members of Highmark Blue Shield and the Western Region s managed care programs have a responsibility to maintain a cooperative physician/patient relationship. Documented occurrences of members not fulfilling their responsibilities may result in a practitioner requesting discharge of the member from his or her practice. Background The relationship between a PCP and his or her members is crucial in the managed care environment. However, sometimes problems can occur which cause a serious rift in the doctor/patient relationship. In such cases, we ask the PCP to attempt to resolve the matter directly with the member. If this does not correct the problem, the PCP is supported in his or her effort to remove the member from the practice. Valid Reasons For Member Removal Valid reasons for discharge of a member include: Patient fraud: All cases of potential fraud and abuse should be reported to Highmark Special Investigations Department at by either the practitioner or the Highmark employee. Abusive behavior: Examples include profanity or threats of physical violence. For mentally competent members over the age of 21, the noted behavior must be exhibited by the member and not by family members. For mentally incompetent adults or minors, the noted behavior must be exhibited by the immediate family members and/or guardians. Medical non-compliance: This includes a member failing to follow a recommended course of treatment. The practitioner must be able to demonstrate that non-compliance has jeopardized, or could likely jeopardize the health/safety of the member. Network procedures non-compliance: This includes a member who has missed more than two appointments within the past 12-month period without appropriate notification. The practitioner must have a written policy that informs the member of the consequences of missed appointments. Continued on next page 6

7 2.4 Member Removal Policy Western Region Only, Continued Valid Reasons For Member Removal (continued) Member fails to meet the financial obligation of the plan: This includes nonpayment of copayments after reasonable effort has been made to collect monies. This does not include outstanding charges the member owes the practitioner prior to the effective date with Highmark or the western region network managed care programs. Legal action: This includes past legal action by the member or legal action that has been threatened against the practitioner or the practitioner s staff. It does not include legal action involving providers other than the practitioner requesting the discharge. Out-of-area members: Members must reside permanently in the network area. For Highmark s western region Medicare Advantage HMO, members may be out of the service area for up to six months while retaining their in-area PCP. Highmark s western region medicare advantage HMO considers any greater period to be a permanent move and the member will be involuntarily disenrolled from the program. Exceptional circumstances: This includes circumstances where the doctor/patient relationship could be jeopardized due to irreconcilable differences between the practitioner and the member. The practitioner should be able to demonstrate/document incidents as shown in the medical record. Providers may also discharge (or not accept) members who were previously removed from the practice but attempt to select the practice again. Members who unknowingly select a practice during open enrollment that has been closed may not be added to the practice. Member Services shall promptly notify the member that the practice is closed and that they will need to select another practice. Continued on next page 7

8 2.4 Member Removal Policy Western Region Only, Continued Invalid Reasons For Removing A Member Invalid reasons for removing a member include: Race Sexual orientation Age (Unless the member s age is outside of the scope of the practice. For example, an adult patient in a pediatric practice.) National origin Diagnosis Physical disability Religion Gender Health status factors (e.g., medical condition, claims experience, receipt of healthcare medical history, genetic information or evidence of insurability) Health care insurance coverage Before You Request Removal... Removing a member from your practice should be used as a last resort. You must make a sincere attempt to resolve the situation with the member prior to requesting his or her removal. Your efforts must be documented in the member s chart. 8

9 2.4 Member Removal Procedure Western Region Only Member Removal The following steps describe the member removal procedure. Stage Who Does It What Happens 1 PCP Identifies the problem, communicates the problem to member or member s legal representative, and documents the problem in the member s medical record. 2 PCP In those situations, where documented evidence of physician/member relationship breakdown exists, the practitioner must send a written request on practice letterhead via mail or fax to the Provider Relations Department. NOTE: It is not necessary to send a written request for PPOBlue, EPOBlue, ClassicBlue or DirectBlue products as they do not require PCP selection. In The Western Region: Provider Relations Member Disenrollment Fifth Avenue Place, Suite Fifth Avenue Place Pittsburgh, PA Western Region Fax: What Region Am I? The request must contain the following information: Member name Member ID # and insurance product Member address Member telephone number Specific documentation of the situation as evidenced in the medical record Evidence that practitioner tried to resolve the situation A practitioner or designee from the practice must sign the request. Continued on next page 9

10 2.4 Member Removal Procedure Western Region Only, Continued Member Removal (continued) Stage Who does it What happens 3 Provider Relations Review the PCP s request: Does the request contain all required information? If yes, proceed to stage 5. If no, and the PCP is unwilling or unable to provide more 4 Medical Director 5 Provider Relations 6 Member Services information, forward the request to the medical director. Review PCP s request: Is the request valid? If yes, proceed to stage 5. If no, call PCP to discuss alternative resolution. Document resolution and forward to Provider Relations. Forward the request to the appropriate member service department. Contact the member and assist with selecting a new PCP. Contact Provider Relations with the effective date of the change. The effective date of the change is the first day of the month after the member has been provided at least 30 days advance notice, unless both provider and member agree to an earlier discharge date. (New provider effective date must always be the first day of a month.) 7 Provider Relations Contact PCP by telephone to confirm the member s removal and effective date. 8 PCP Provide access to services until the termination date Provide urgent care if necessary. If requested to do so by the member or Highmark, the practitioner must, at no cost to the patient, forward medical records to the new PCP within thirty days. 10

11 2.4 How To Close And Re-Open Your Practice To Members Introduction This section is intended to explain how to close and re-open your practice to new members. Definition: Closed Practices When a practice is closed to new members, it means that the PCP practice is temporarily not available for selection by new members. Definition: New Member A new member is one who has: Never been seen by a physician of the practice Not been seen by a physician of the practices within the past 36 months. Rationale By closing to new members, your practice can limit the number of new members. This can be especially helpful to practices that are new to managed care, or to practices that have a shortage of physicians or office staff. Guidelines Your practice must provide written notice to the western region network 60 days prior to the anticipated closing date and/or re-opening date. Closure takes place on the first day of the month following the 60-day period. You must continue to accept new members up to the end of the 60-day period when closure is in place. You must accept existing members who choose you as their PCP. You must close to all new Highmark plan members. How To Close Or Re-Open Your Practice To close or to re-open your practice to new members, simply mail or fax written notification on practice letterhead, including practice name, address, vendor number, effective date, and authorized signature for the requested change, to: What Region Am I? Western, Central and Eastern PA Regions: Highmark Blue Shield Provider Information Management P.O. Box Camp Hill, PA Fax: Northeastern PA Region: Blue Cross of Northeastern Pennsylvania Provider System Support 19 North Main Street Wilkes-Barre, PA Fax:

12 2.4 Eligibility Rosters Definition The Eligibility Roster is a list of members currently enrolled with a specific primary care practice. Purpose The Eligibility Roster is intended to give PCP practices a way to identify which members are assigned to their practice for any given month. The Eligibility Roster contains no financial information other than the co-payment that you may collect from the member for office visits. Report Frequency Eligibility rosters are available online monthly through NaviNet. For those practices that do not have NaviNet, the rosters are mailed at the end of each month. The roster contains enrollment information for the following month. How To Download Eligibility Rosters 1. In the NaviNet toolbar, select Report Inquiry. 2. Select Eligibility Roster in the Report Type Field. Click Search. 3. Choose month desired. Click Select. 4. Select Download. The generated file will be in.txt format. Select Save or Open based on your preference. Single Roster Each PCP practice receives a single roster that is separated by product. Rosters are available for the following products: DirectBlue, Western Region Individual HMO and Western Region Medicare Advantage HMO. Rosters for DirectBlue (group) members will only be printed if the member selected a PCP. Members do not formally choose a PCP for certain products including, but not limited to DirectBlue (individual), PPOBlue EPOBlue and ClassicBlue so a roster is not produced for those products. Information Contained On The Roster Eligibility rosters list the names and identification numbers of all members enrolled in a PCP s practice. 12

13 2.4 How To Read The Eligibility Roster Information Fields On The Roster This table lists each field on the roster with an explanation of its function. Please refer to the example illustration following the table. Field RUN DATE RUN TIME PRODUCT PRACTICE NAME PCP NUMBER STAT CHG MEMBER NAME MEMBER ID MEM NUM GROUP NUMBER SEX AGE Function Run date and time indicates when the roster was printed for the monthly period identified on the roster. The roster is separated by product. The product s name and code appear at the top of the roster to identify the product. The practice name and PCP number. The field will also show the reimbursement method of the practice for each product: FFS (fee-for-service). Status change indicates new or terminated members to the provider since the last eligibility roster. A = New member added T = Member terminated Member name listed alphabetically (last name, first name) Identification number is the subscriber s unique member identifier assigned to all members of the family who are enrolled under the subscriber s coverage. Member number is a two-digit number that notes the member covered. For example: 00 = subscriber 01 = spouse or dependent 02 and up = additional dependents Group number identifies the employer group or the benefit plan for which the member is eligible. Shows the member s sex. Shows the member s age. Continued on next page 13

14 2.4 How To Read The Eligibility Roster, Continued Information Fields On The Roster (continued) Field BEGIN DATE END DATE FINANCIAL INDICATOR COPAY Function Begin date is the date the member enrolled with the provider under the given group number. End date is the date the member cancelled with the provider under the given group number. Financial indicator shows the member s employer group s financial arrangements relative to managed care. F = Fee-for-service Shows the co-payment that you may collect from the member for office visits. Continued on next page 14

15 2.4 How To Read The Eligibility Roster, Continued Illustration An illustration of an Eligibility Roster appears below. This statement is for example purposes only. Line and/or page totals may be mathematically inaccurate. 15

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

Early Intervention Central Billing Office. Provider Insurance Billing Procedures

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,

More information

Memorial Hermann Advantage (HMO)

Memorial Hermann Advantage (HMO) Memorial Hermann Advantage (HMO) 2016 Enrollment Form Follow these easy steps to enroll in a Memorial Hermann Advantage Health Maintenance Organization (HMO). 1. Each applicant must fill out a separate

More information

Highmark Blue Shield Provider Information Management P.O. Box 898842 Camp Hill, PA 17089-8842

Highmark Blue Shield Provider Information Management P.O. Box 898842 Camp Hill, PA 17089-8842 Dear Health Care Professional: The enclosed forms are provided to process your request for an Assignment Account number with Highmark Blue Shield. An Assignment Account is Highmark Blue Shield s term for

More information

MEMBER S NAME (LAST, FIRST, M.I.) MEMBER ID OR SSN PHONE NUMBER ( ) PHYSICAL ADDRESS (CANNOT BE A PO BOX) COUNTY OF RESIDENCE EMAIL ADDRESS

MEMBER S NAME (LAST, FIRST, M.I.) MEMBER ID OR SSN PHONE NUMBER ( ) PHYSICAL ADDRESS (CANNOT BE A PO BOX) COUNTY OF RESIDENCE EMAIL ADDRESS Department of Technology, Management & Budget Office of Retirement Services www.michigan.gov/ors (800) 381-5111 P.O. Box 30171 Lansing, MI 48909-7671 Insurance Enrollment/Change Request MEMBER S NAME (LAST,

More information

Section 4: Physicians and Providers

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

More information

FLATIRON PEDIATRICS. What You Need to Know about Your Health Plan Coverage and Our Financial Policies EFFECTIVE SEPTEMBER 2014

FLATIRON PEDIATRICS. What You Need to Know about Your Health Plan Coverage and Our Financial Policies EFFECTIVE SEPTEMBER 2014 What You Need to Know about Your Health Plan Coverage and Our Financial Policies EFFECTIVE SEPTEMBER 2014 *Please read & return last page* Introduction We are privileged to have you as our patient, and

More information

Welcome Information. Registration: All patients must complete a patient information form before seeing their provider.

Welcome Information. Registration: All patients must complete a patient information form before seeing their provider. Welcome Information Thank you for choosing our practice to take care of your health care needs! We know that you have a choice in selecting your medical care and we strive to provide you with the best

More information

FREQUENTLY ASKED QUESTIONS ID CARDS / ELIGIBILITY / ENROLLMENT

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

More information

2010 BCBSNC Provider Conference Top 20 Questions Answers

2010 BCBSNC Provider Conference Top 20 Questions Answers Questions Answers There is currently no centralized listing of all out-of-state Blue Plan alpha prefixes. There is a listing available for BCBSNC alpha prefixes only; please contact your Provider Relations

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

Enrollment Application. Senior Blue Traditional Blue Medicare PPO

Enrollment Application. Senior Blue Traditional Blue Medicare PPO MEDICARE ADVANTAGE Enrollment Application Senior Blue Traditional Blue Medicare PPO 30 Century Hill Drive, Latham, NY 12110 1-800-700-8482 Toll Free TTY/TDD (Hearing Impaired) 1-877-513-1470 Monday through

More information

Unit 1 Core Care Management Activities

Unit 1 Core Care Management Activities Unit 1 Core Care Management Activities Healthcare Management Services Healthcare Management Services (HMS) is responsible for all the medical management services provided to Highmark Blue Shield members,

More information

Chapter 5 Claims Submission Unit 1: Benefits of Electronic Communication

Chapter 5 Claims Submission Unit 1: Benefits of Electronic Communication Chapter 5 Claims Submission Unit 1: Benefits of Electronic Communication In This Unit Topic See Page Unit 1: Benefits of Electronic Communication Electronic Connections 2 Electronic Claim Submission Benefits

More information

Application for Individual Health & Dental Insurance

Application for Individual Health & Dental Insurance Application for Individual Health & Dental Insurance (For plans effective 1/1/2015 and after) PO Box 14527 Des Moines, Iowa 50306-3527 DIRECTIONS If you are applying for a new policy during Open Enrollment,

More information

Eligibility, Enrollment, Disenrollment & Grace Period

Eligibility, Enrollment, Disenrollment & Grace Period Section 2. Eligibility, Enrollment, Disenrollment & Grace Period Enrollment Enrollment in Ohio s Marketplace Program The Centers for Medicare and Medicaid Services (CMS) is the program which implements

More information

PATIENT FINANCIAL POLICIES Effective Date: June 1, 2015

PATIENT FINANCIAL POLICIES Effective Date: June 1, 2015 Cardiovascular Specialists of Central Maryland A Community Specialty Practice of Johns Hopkins Medicine 10710 Charter Drive, Suite 400 Columbia MD 21044 PATIENT FINANCIAL POLICIES Effective Date: June

More information

Patient Rights and Responsibilities

Patient Rights and Responsibilities Patient Rights and Responsibilities As a patient, you have the right Personal Privacy/Visitation To have your personal dignity respected. To the confidentiality of your identifiable health information.

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

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

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

1. Name of applicant Last First Middle. Home Phone FAX number E-mail address. Complete title of your medical professional designation

1. Name of applicant Last First Middle. Home Phone FAX number E-mail address. Complete title of your medical professional designation 2 Park Avenue 8 British American Blvd. New York, NY 10016 Latham, NY 12110 Tel: 212-576-9800 Tel: 518-786-2700 2 Clinton Square 90 Merrick Avenue Syracuse, NY 13202 East Meadow, NY 11554 Tel: 315-428-1188

More information

Member Administration

Member Administration Member Administration I.2 Member Identification Cards I.4 Provider and Member Rights and Responsibilities I.5 Identifying Members and Verifying Eligibility I.9 Determining Primary Insurance Coverage I.16

More information

Application for Individual Health Insurance

Application for Individual Health Insurance Application for Individual Health Insurance (For plans effective 1/1/2015 and after) PO Box 5023 Sioux Falls, South Dakota 57117-5023 DIRECTIONS If you are applying for a new policy during Open Enrollment,

More information

Medical Assisting Review

Medical Assisting Review Fifth Edition Medical Assisting Review Passing the CMA, RMA, and CCMA Exams Chapter 14 Medical Insurance 14-2 Learning Outcomes 14.1 Define terminology used in association with medical insurance. 14.2

More information

WELCOME TO PCCMA. We look forward to being of service to you and helping you to be healthier in the future.

WELCOME TO PCCMA. We look forward to being of service to you and helping you to be healthier in the future. Phone: 717-234-2561 Franklyn J. Myers, III, M.D., F.C.C.P. Alexis B. Aaronson, M.S.N, C.R.N.P. Michele M. Knepper, C.R.N.P. WELCOME TO PCCMA Welcome to our practice. We are specialists in the treatment

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

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

Consumer s Right to Know About Health Plans in Rhode Island

Consumer s Right to Know About Health Plans in Rhode Island Consumer s Right to Know bout Health Plans in Rhode Island BasicBlue BLUE CROSS & BLUE SHIELD of RHODE ISLND January 1, 2016 Consumer Disclosure Safe and Healthy Lives in Safe and Healthy Communities Consumer

More information

2016 Enrollment Form

2016 Enrollment Form 2016 Enrollment Form White Copy Enrollment Yellow Copy Agent Pink Copy Member Simply Healthcare Scope Lead ID: Black & White Logos Proposed Effective Date of Coverage: Horizontal 2016 Enrollment Request

More information

Magellan Behavioral Care of Iowa, Inc. Provider Handbook Supplement for Iowa Autism Support Program (ASP)

Magellan Behavioral Care of Iowa, Inc. Provider Handbook Supplement for Iowa Autism Support Program (ASP) Magellan Behavioral Care of Iowa, Inc. Provider Handbook Supplement for Iowa Autism Support Program (ASP) 2014 Magellan Health Services Table of Contents SECTION 1: INTRODUCTION... 3 Welcome... 3 Covered

More information

TRICARE SENIOR PRIME ENROLLMENT APPLICATION

TRICARE SENIOR PRIME ENROLLMENT APPLICATION TRICARE SENIOR PRIME ENROLLMENT APPLICATION Form Approved OMB No. 0720-0018 Expires Aug 31, 2002 FOR OFFICIAL USE ONLY: PROPOSED EFFECTIVE DATE OF COVERAGE The public reporting burden for this collection

More information

Sincerely yours, Rev. 06.10

Sincerely yours, Rev. 06.10 Welcome to RehabXperience. Thank you so much for choosing us. We recognize that you have a choice of physical therapy centers and greatly appreciate you for choosing us as your outpatient physical therapy

More information

MVP Health Care Frequently Asked Questions/General Information

MVP Health Care Frequently Asked Questions/General Information Q: What is the relationship between MVP and ValueOptions? A. ValueOptions administers the mental health and substance abuse benefits for MVP. MVP has contracted with ValueOptions, Inc. (ValueOptions )

More information

Providers. General Responsibilities. Uniformed Services Family Health Plan. Provider Update

Providers. General Responsibilities. Uniformed Services Family Health Plan. Provider Update Commercial Provider Manual Providers General Responsibilities Tufts Health Plan providers agree to comply with all state or federal laws and regulations applicable to Tufts Health Plan products in arranging

More information

If you need instructions on how to obtain a contract for your Non Par Tax ID, click here.

If you need instructions on how to obtain a contract for your Non Par Tax ID, click here. If you need instructions on how to obtain a contract for your Non Par Tax ID, click here. If you need instructions on how to add Physicians to your existing Group Contract, click here. Anthem Blue Cross

More information

Red Flag Policy and Procedures for Alexander Orthopaedic Associates

Red Flag Policy and Procedures for Alexander Orthopaedic Associates Red Flag Policy and Procedures for Alexander Orthopaedic Associates The Identify Theft Prevention Program developed by Alexander Medical Group LLC dba Alexander Orthopaedic Associates referred throughout

More information

Patient Information Form Trinity Wellness Center. Insurance Information

Patient Information Form Trinity Wellness Center. Insurance Information Patient Information Form Trinity Wellness Center Last Name, First Name, MI* Date of Birth* / / Social Security # -- -- Sex* : Female / Male Student Status (circle one): Full-time / Part-time / not a student

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

2013 MEDIGAP BLUE REFERENCE GUIDE

2013 MEDIGAP BLUE REFERENCE GUIDE 2013 MEDIGAP BLUE REFERENCE GUIDE HIGHMARK SENIOR MARKETS 01/01/2013 REFERENCE GUIDE TABLE OF CONTENTS Section 1: How to Submit an Application... 3 Section 2: Medical Underwriting... 6 Section 3: Effective

More information

Arizona Health Care Cost Containment System

Arizona Health Care Cost Containment System Arizona Health Care Cost Containment System Manual: Office of Managed Care Effective Date: August 1, 1994 Policy and Procedures Revision Date: February 1, 2003 Subject: 402 Change of Plan Policy Authorized

More information

OFFICE POLICIES, EFFECTIVE October 19, 2009

OFFICE POLICIES, EFFECTIVE October 19, 2009 Thank you for choosing our office for your medical care. We have written these policies to keep you informed of our current office policies. Please refer to our website for policy updates. OFFICE POLICIES,

More information

SUBSTANCE ABUSE FACILITY GENERAL INFORMATION

SUBSTANCE ABUSE FACILITY GENERAL INFORMATION SUBSTANCE ABUSE FACILITY GENERAL INFORMATION I. BCBSM s Substance Abuse Facility Programs Traditional The Traditional BCBSM Substance Abuse Program provides benefits for the treatment of substancerelated

More information

September 15, 2009. <<First>> <<Last>> <<Address>> <<City>>, <<State>> <<Zip>> SUBJECT: CALPERS RETIREE HEALTH INSURANCE

September 15, 2009. <<First>> <<Last>> <<Address>> <<City>>, <<State>> <<Zip>> SUBJECT: CALPERS RETIREE HEALTH INSURANCE C Office of Employer and Member Health Services P.O. Box 942714 Sacramento, CA 94229-2714 (888) CalPERS 225-7377 Telecommunications Device for the Deaf - 916-795-3240 FAX 916-795-1277 September 15, 2009

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

MEDICARE ADVANTAGE INDIVIDUAL ENROLLMENT ELECTION FORM

MEDICARE ADVANTAGE INDIVIDUAL ENROLLMENT ELECTION FORM MEDICARE ADVANTAGE INDIVIDUAL ENROLLMENT ELECTION FORM Please contact ONECare by Care1st Health Plan Arizona, Inc. (HMO) if you need information in another language or format (Braille). TO ENROLL IN ONECARE,

More information

RiverSpring Star (HMO SNP) Enrollment Request Form

RiverSpring Star (HMO SNP) Enrollment Request Form RiverSpring Star (HMO SNP) Enrollment Request Form Please contact RiverSpring (HMO SNP) if you need information in another language or format (Braille). To Enroll in RiverSpring Star (HMO SNP), Please

More information

Updated as of 05/15/13-1 -

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

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

Independence Blue Cross Individual Application Instructions

Independence Blue Cross Individual Application Instructions Independence Blue Cross Individual Application Instructions To apply for a Healthcare Reform compliant health insurance policy from Independence Blue Cross, please complete the following application and

More information

HALFWAY HOUSE FACILITY APPLICATION FOR PARTICIPATION IN BCBSM S MENTAL HEALTH AND SUBSTANCE ABUSE MANAGED CARE NETWORK(S) GENERAL INFORMATION

HALFWAY HOUSE FACILITY APPLICATION FOR PARTICIPATION IN BCBSM S MENTAL HEALTH AND SUBSTANCE ABUSE MANAGED CARE NETWORK(S) GENERAL INFORMATION HALFWAY HOUSE FACILITY APPLICATION FOR PARTICIPATION IN BCBSM S MENTAL HEALTH AND SUBSTANCE ABUSE MANAGED CARE NETWORK(S) GENERAL INFORMATION I. BCBSM s Halfway House Facility Program for the State of

More information

PATIENT INTAKE FORM PATIENT INFORMATION. Name Soc. Sec. # Last Name First Name Initial Address. City State Zip. Home Phone Work/Mobile Phone

PATIENT INTAKE FORM PATIENT INFORMATION. Name Soc. Sec. # Last Name First Name Initial Address. City State Zip. Home Phone Work/Mobile Phone PATIENT INTAKE FORM PATIENT INFORMATION Name Soc. Sec. # Last Name First Name Initial Address City State Zip Home Phone Work/Mobile Phone Sex M F Age Birth date Single Married Widowed Separated Divorced

More information

LAST Name: FIRST Name: Middle Initial 9 Mr. 9 Mrs. 9 Ms. Sex: 9 M 9 F

LAST Name: FIRST Name: Middle Initial 9 Mr. 9 Mrs. 9 Ms. Sex: 9 M 9 F 705 Mt. Auburn Street, Watertown, MA 02472 2015 HMO INDIVIDUAL ENROLLMENT FORM Please contact Tufts Health Plan Medicare Preferred if you need information in another language or format (Braille). To Enroll

More information

1. Name of applicant Last First Middle. Complete title of your medical professional designation. 12:01 AM E.S.T. on Month Day Year

1. Name of applicant Last First Middle. Complete title of your medical professional designation. 12:01 AM E.S.T. on Month Day Year 2 Park Avenue 8 British American Blvd. New York, NY 10016 Latham, NY 12110 Tel: 212-576-9800 Tel: 518-786-2700 2 Clinton Square 90 Merrick Avenue Syracuse, NY 13202 East Meadow, NY 11554 Tel:315-428-1188

More information

Enrollment Application Instructions 2015 Plan Year

Enrollment Application Instructions 2015 Plan Year Enrollment Application Instructions 2015 Plan Year Please read before completing your enrollment request form. You are eligible to join Care N Care Health Plan(s) HMO if: You are entitled to Medicare Part

More information

Enrollment Application

Enrollment Application 2015 MEDICARE ADVANTAGE Enrollment Application Senior Blue HMO Forever Blue Medicare PPO Optional Supplemental Dental If you have any questions, we re here to help! bcbswny.com/medicare 1-800-248-9296

More information

Provider Information Change Form I. PERSONAL INFORMATION

Provider Information Change Form I. PERSONAL INFORMATION Internal #: For Internal Use Only (Individual Application) Reason: New Provider Provider Information Change Form I. PERSONAL INFORMATION Name:.. First Middle Last Suffix Degree (MD,RN, etc.) Gender: M

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

HEALTH INSURANCE APPEALS

HEALTH INSURANCE APPEALS Your Guide to filing HEALTH INSURANCE APPEALS Sometimes a health plan will make a decision that you disagree with. The plan may deny your application for coverage, determine that the healthcare services

More information

The Pennsylvania Insurance Department s. Your Guide to filing HEALTH INSURANCE APPEALS

The Pennsylvania Insurance Department s. Your Guide to filing HEALTH INSURANCE APPEALS Your Guide to filing HEALTH INSURANCE APPEALS Sometimes a health plan will make a decision that you disagree with. The plan may deny your application for coverage, determine that the healthcare services

More information

OSCAR Health Insurance Frequently Asked Questions/General Information

OSCAR Health Insurance Frequently Asked Questions/General Information Q: What is the relationship between Oscar and ValueOptions? A. ValueOptions administers the mental health and substance abuse benefits for Oscar Health Insurance. They have contracted with ValueOptions,

More information

NEW JERSEY MEDICARE FAQs FREQUENTLY ASKED QUESTIONS FROM PROVIDERS

NEW JERSEY MEDICARE FAQs FREQUENTLY ASKED QUESTIONS FROM PROVIDERS NEW JERSEY MEDICARE FAQs To help answer some of the most frequently asked questions we receive from providers and members, please see below. If you have a question that isn't listed here, or if you need

More information

Understanding Your Role in Maximizing Revenue in a FQHC

Understanding Your Role in Maximizing Revenue in a FQHC Understanding Your Role in Maximizing Revenue in a FQHC Cynthia M Patterson President N Charleston SC 29420-1093 Firstchoice.practicesolutions@gmail.com P: (843) 597-8437 F: (888) 697-8923 Have systems

More information

PacifiCare of Oklahoma, Inc.

PacifiCare of Oklahoma, Inc. PacifiCare of Oklahoma, Inc. Welcome to PacifiCare When you chose PacifiCare as your health care plan, you opened the door to many benefits, services and resources designed to keep you healthy. This booklet

More information

SECTION 15 (HIPAA-CHIP) ELIGIBILITY AND ENROLLMENT FORM COMPLETE ALL OF THE FOLLOWING QUESTIONS IN THEIR ENTIRETY (Please print)

SECTION 15 (HIPAA-CHIP) ELIGIBILITY AND ENROLLMENT FORM COMPLETE ALL OF THE FOLLOWING QUESTIONS IN THEIR ENTIRETY (Please print) I C H I P Illinois Comprehensive Health Insurance Plan STATE OF ILLINOIS COMPREHENSIVE HEALTH INSURANCE PLAN (CHIP) 400 West Monroe Street, Suite 202, Springfield, Illinois 62704-1823 1-866-851-2751 (toll-free

More information

Medical Nutrition Therapy Dietitians Caring for Our Members Health

Medical Nutrition Therapy Dietitians Caring for Our Members Health Medical Nutrition Therapy Dietitians Caring for Our Members Health BCBSNC Dietitian Network 1 2014, Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield

More information

INDEPENDENT HEALTHCARE PROVIDER SERVICES AGREEMENT

INDEPENDENT HEALTHCARE PROVIDER SERVICES AGREEMENT INDEPENDENT HEALTHCARE PROVIDER SERVICES AGREEMENT This Independent Healthcare Provider Services Agreement (the Agreement ) by and between ("Provider") a licensed physician or licensed nurse/healthcare

More information

To Enroll in Capital Health Plan in 2015, Please Provide the Following Information:

To Enroll in Capital Health Plan in 2015, Please Provide the Following Information: Plan Use Only: Contract #: Group #: Member ID: Please contact Capital Health Plan if you need information in another language or format (Braille). To Enroll in Capital Health Plan in 2015, Please Provide

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

A Guide to Long Term Disability Benefits

A Guide to Long Term Disability Benefits A Guide to Long Term Disability Benefits The University of Maine System is proud to offer a Long Term Disability (LTD) plan to eligible employees. Long term disability is defined as a severe illness or

More information

Member Handbook A brief guide to your health care coverage

Member Handbook A brief guide to your health care coverage Member Handbook A brief guide to your health care coverage Preferred Provider Organization Plan Using the Private Healthcare Systems Network PREFERRED PROVIDER ORGANIZATION (PPO) PLAN USING THE PRIVATE

More information

OUTPATIENT PHYSICAL THERAPY FACILITY APPLICATION FOR BCBSM PARTICIPATION FOR THE TRADITIONAL PROGRAM AND/OR THE MEDICARE SUPPLEMENTAL PROGRAM AND BCN

OUTPATIENT PHYSICAL THERAPY FACILITY APPLICATION FOR BCBSM PARTICIPATION FOR THE TRADITIONAL PROGRAM AND/OR THE MEDICARE SUPPLEMENTAL PROGRAM AND BCN OUTPATIENT PHYSICAL THERAPY FACILITY APPLICATION FOR BCBSM PARTICIPATION FOR THE TRADITIONAL PROGRAM AND/OR THE MEDICARE SUPPLEMENTAL PROGRAM AND BCN GENERAL INFORMATION I. BCBSM s (Freestanding) Outpatient

More information

Faculty Group Practice Patient Demographic Form

Faculty Group Practice Patient Demographic Form Name (Last, First, MI) Faculty Group Practice Patient Demographic Form Today s Date Patient Information Street Address City State Zip Home Phone Work Phone Cell Phone ( ) Preferred ( ) Preferred ( ) Preferred

More information

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

My Health Insurance Comparison Worksheet

My Health Insurance Comparison Worksheet My Health Insurance Comparison Worksheet This worksheet will help you compare three health insurance options. Use the health insurance information provided to you by the insurance company to fill in the

More information

ADDENDUM 1 MEDICAL HOME TO SOONERCARE PHYSICIAN AGREEMENT FOR CHOICE PRIMARY CARE PROVIDERS

ADDENDUM 1 MEDICAL HOME TO SOONERCARE PHYSICIAN AGREEMENT FOR CHOICE PRIMARY CARE PROVIDERS ADDENDUM 1 MEDICAL HOME TO SOONERCARE PHYSICIAN AGREEMENT FOR CHOICE PRIMARY CARE PROVIDERS 1.0 PURPOSE The purpose of this Addendum is for OHCA and PROVIDER to contract for PCP services in OHCA s SoonerCare

More information

PA PROMISe 837 Institutional/UB 04 Claim Form

PA PROMISe 837 Institutional/UB 04 Claim Form Table of Contents 2 1 Appendix H Bureau of Provider Support (BPS) Field Operations Review Process Contents: A. General Background B. Explanation of Forms and Terms used in the Field Operations Section

More information

9.0 Government Safety Net Programs

9.0 Government Safety Net Programs 9.0 Government Safety Net Programs 9.1 Medicaid Managed Care, Child Health Plus and Family Health Plus Note: This section does not apply to Healthy New York, another government safety net program with

More information

Instructions to help you complete your enrollment form for the HPHC Medicare Supplement Plan

Instructions to help you complete your enrollment form for the HPHC Medicare Supplement Plan Instructions to help you complete your enrollment form for the HPHC Medicare Supplement Plan Massachusetts THIS ENROLLMENT FORM IS IN SECTIONS. PLEASE REMOVE THIS TAB TO SEPARATE THE SECTIONS BEFORE YOU

More information

Empire MediBlue (HMO) Individual Enrollment Request Form 2014

Empire MediBlue (HMO) Individual Enrollment Request Form 2014 Empire MediBlue (HMO) Individual Enrollment Request Form 2014 Be sure to complete the entire enrollment form. Then, mail the completed form to P.O. Box 659403, San Antonio, TX 78265-9714 or fax the completed

More information

Office Policies Dear Patient: We would like to take the opportunity to explain the policies of our office. Please take notice of the following:

Office Policies Dear Patient: We would like to take the opportunity to explain the policies of our office. Please take notice of the following: Office Policies Dear Patient: We would like to take the opportunity to explain the policies of our office. Please take notice of the following: Please contact our answering service after hours for EMERGENCY

More information

Warner Family Counseling

Warner Family Counseling Warner Family Counseling General Policies Insurance: I will file claims on your behalf, provided that I am an in-network contracted provider with your individual plan. Prior to our first meeting contact

More information

Medical Coverage Policy Electronic Health Record Payment

Medical Coverage Policy Electronic Health Record Payment Medical Coverage Policy Electronic Health Record Payment Device/Equipment Drug Medical Surgery Test Other Effective Date: 5/1/2011 Policy Last Updated: 5/14/2012 Prospective review is recommended/required.

More information

Consumer s Right to Know About Health Plans in Rhode Island

Consumer s Right to Know About Health Plans in Rhode Island Consumer s Right to Know bout Health Plans in Rhode Island BlueCHiP BLUE CROSS & BLUE SHIELD of RHODE ISLND January 1, 2016 Consumer Disclosure Safe and Healthy Lives in Safe and Healthy Communities Consumer

More information

APPLICATION FOR NEW INDIVIDUAL/FAMILY PLAN HEALTH INSURANCE

APPLICATION FOR NEW INDIVIDUAL/FAMILY PLAN HEALTH INSURANCE APPLICATION FOR NEW INDIVIDUAL/FAMILY PLAN HEALTH INSURANCE PLEASE COMPLETE STEPS 1-6. If you are an insurance agent/producer, please complete Steps 1-7. STEP 1) Find your county in the list below and

More information

Priority Health Medicare

Priority Health Medicare Priority Health Medicare To enroll online please visit our website at prioritymedicare.com Enrollment instructions To avoid delays in processing your enrollment, please follow these helpful tips. Make

More information

Aetna Golden Medicare Plan Aetna Golden Choice Plan

Aetna Golden Medicare Plan Aetna Golden Choice Plan Group Administration Manual Aetna Golden Medicare Plan Aetna Golden Choice Plan 7A-31168 (12/03) Group Administration Manual Overview The Aetna Golden Medicare Plan and the Aetna Golden Choice Plan are

More information

P.O. Box 91120, MS 295 Seattle, WA 98111-9220 1-800-752-6663 Fax: 425-918-5278

P.O. Box 91120, MS 295 Seattle, WA 98111-9220 1-800-752-6663 Fax: 425-918-5278 Washington Medicare Supplement Enrollment Application for Plans A, F, High Deductible F and N P.O. Box 91120, MS 295 Seattle, WA 98111-9220 1-800-752-6663 Fax: 425-918-5278 ou are eligible to apply for

More information

Enrollment Form. Harvard Pilgrim Health Care MAPD Individual Enrollment Request Form ENROLLMENT INSTRUCTIONS

Enrollment Form. Harvard Pilgrim Health Care MAPD Individual Enrollment Request Form ENROLLMENT INSTRUCTIONS Enrollment Form Harvard Pilgrim Health Care MAPD Individual Enrollment Request Form ENROLLMENT INSTRUCTIONS The following steps must be completed to become a member of Harvard Pilgrim Health Care - an

More information

Optima Health Plan and Optima Health Insurance Company Enrollment Application and Waiver 51-99 Coordination of Benefits

Optima Health Plan and Optima Health Insurance Company Enrollment Application and Waiver 51-99 Coordination of Benefits 4417 Corporation Lane Virginia Beach, VA 23462 Subscriber #: Date: FOR PLAN USE ONLY Optima Health Plan and Optima Health Insurance Company Enrollment Application and Waiver 51-99 Coordination of Benefits

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

Please Note: Please send all documentation related to the credentialing portion of this documentation to:

Please Note: Please send all documentation related to the credentialing portion of this documentation to: Please ote: The application process is split into different actions. Please send all documentation related to the contracting portion of this documentation to: Fax to: (916)350-8860 Or email to: BSCproviderinfo@blueshieldca.com

More information

Cigna Medicare Advantage HMO Plans 2016 Enrollment Request Form Please contact Cigna if you need information in another language or format (Braille).

Cigna Medicare Advantage HMO Plans 2016 Enrollment Request Form Please contact Cigna if you need information in another language or format (Braille). Cigna Medicare Advantage HMO Plans 2016 Enrollment Request Form Please contact Cigna if you need information in another language or format (Braille). To Enroll in Cigna Preferred/Preferred Plus/Achieve

More information

Patient Resource Guide for Billing and Insurance Information

Patient Resource Guide for Billing and Insurance Information Patient Resource Guide for Billing and Insurance Information 17 Patient Account Payment Policies July 2012 Update Lexington Clinic Central Business Office Payment Policies Customer service...2 Check-in...2

More information

Informed Consent for Therapy Services Adult PSYCHOLOGIST-CLIENT SERVICE AGREEMENT

Informed Consent for Therapy Services Adult PSYCHOLOGIST-CLIENT SERVICE AGREEMENT Serenity Through Enrichment Psychological Services, LLC Nakia Perry-Goffney, PsyD, MA, LCP serenitythruenrichment@gmail.com 2915 Hunter Mill Road Suite 14 (571)723-2321 (office) Oakton, VA 22124 (571)319-8175

More information

Name of prescription drug you are requesting (if known, include strength and quantity requested per month): Type of Coverage Determination Request

Name of prescription drug you are requesting (if known, include strength and quantity requested per month): Type of Coverage Determination Request REQUEST FOR MEDICARE PRESCRIPTION DRUG COVERAGE DETERMINATION This form may be sent to us by mail or fax: Address: Fax Number: Blue Cross Medicare Advantage 1-800-693-6703 Attn: Clinical Review Department

More information

REGISTRATION AUTISM TREATMENT SERVICES

REGISTRATION AUTISM TREATMENT SERVICES 559 Zor Shrine Place Madison, WI 53719 P: 608.833.0123 F: 608.833.0126 www.ids -wi.com CLIENT INFORMATION (First, MI, Last) (Street, City, State, Zip) REGISTRATION AUTISM TREATMENT SERVICES of Birth Home

More information

DISCLOSURE AND CONSENT FORM

DISCLOSURE AND CONSENT FORM SCA INTAKE DOCUMENTS Thank you for your interest in Southwest Counseling Associates. This package contains all the documents you would typically receive when you arrive for your first session with an SCA

More information

To Enroll in Cigna HealthSpring Preferred Plus, Please Provide the Following Information:

To Enroll in Cigna HealthSpring Preferred Plus, Please Provide the Following Information: Cigna HealthSpring Preferred Plus (HMO) Medicare Advantage Plan 2015 Enrollment Request Form Please contact Cigna HealthSpring Preferred Plus if you need information in another language or format (Braille).

More information

If you miss 3 consecutive appointments we may have to notify your physician and will require a new referral in order to continue your treatment.

If you miss 3 consecutive appointments we may have to notify your physician and will require a new referral in order to continue your treatment. Welcome to POST Physical Therapy Brookline. We strive to provide our patients with excellent service and quality care. Our commitment to your well-being and health care is something that we at POST Physical

More information