[PDF] Top 20 2013 Provider Administrative Manual

... ► The provider has the right to correct erroneous information. If practitioner/provider indicates there is a need to provide corrected information, such corrections must be received within two weeks of ... See full document

... a Provider Services Web site so dentists can follow the decision matrix and understand the logic behind UM ...reduces Provider administrative ... See full document

... information regarding performance measurement, including HEDIS . Submission of CPT Category II Codes allows data to be captured at the time of service, thus reducing the need for retrospective medical record review . Use ... See full document

... the administrative oversight authority and coordination of all delegated ...Credentialing, Provider Relations, Corporate Compliance, Medicare Compliance, Medicaid Compliance, Regulatory Affairs, Medical ... See full document

... HIPAA Administrative Simplification ASC X12 837 standards and additional WellCare specific requirements in the WellCare Companion Guide, including all then current guidelines regarding coding and inclusive code ... See full document

... and Provider Relations department can be reached toll-free at ...Our Provider Relations Specialists work in unison with our team of phone staff (Customer Service representatives) to assist providers and ... See full document

... The right to a hearing under this peer review process is strictly limited to cases in which professional review action is necessary to address quality of care, competence, or conduct concerns that would affect care ... See full document

... Ambetter’s culture, systems and processes are structured around its mission to improve the health of all enrolled members. The Quality Assessment and Performance Improvement (QAPI) Program utilizes a systematic approach ... See full document

... Fidelis SecureCare has put a process in place to ease the administrative burden of long term care facilities in these instances. Each month when the Patient Credit File is received, Fidelis SecureCare will check ... See full document

... a provider services representative after you've searched online for the answer to a claims status or eligibility ..."Ask Provider Services" button at the bottom of the ... See full document

... time. The DNBE policy will apply to all Claims for all Members enrolled in HealthSpan. HealthSpan expects Plan Providers to report every DNBE as set forth in Section 8.31 of this HealthSpan Medicare Advantage ... See full document

... Depending on the benefit plan, Kaiser Permanente Members may be responsible to share some cost of the services provided. Copayment, co- insurance and deductible (collectively, “Member Cost Share”) are the fees a Member ... See full document

... A patient who requires a referral to a dental specialist can be referred directly to any specialist contracted with Commonwealth Care Alliance without authorization from Scion Dental. The dental specialist is responsible ... See full document

... Confidentiality of member information must be maintained at all times. Records are to be stored securely with access granted to authorized personnel only. Access to records should be granted to WellCare, or its ... See full document

... A provider may appeal a utilization or claim denial on his or her own behalf by mailing or faxing to Harmony a letter of appeal and/or a Provider Appeal Request Form with supporting documentation such as ... See full document

... WellCare offers Specialty Pharmacy services to members who are taking medications to treat long-term, life-threatening or rare conditions. WellCare’s Specialty Pharmacy team are experts in the special handling, storage ... See full document

... for provider claim ...the provider for the services or in a request, prior to payment, for the submission for review of medical records that relate to the ... See full document

... Manual scavenger is class person which is often ignored when it comes to protection of human rights, civil rights or fundamental rights granted under Constitution of India. These are the people who suffer from ... See full document

... retroactively. The provider who has filed a claim for an outdated amount will receive the lower amount as indicated on the claim. The dentist can correct such claims, but usually only by resubmitting all the ... See full document

... The provider acknowledges and agrees that no reimbursement is due for a Covered Service and/or no claim is complete for a Covered Service unless performance of that Covered Service is fully and accurately ... See full document