Reference Materials

• 2023 Provider and Billing Manual (PDF)
• 2022 Provider and Billing Manual (PDF)
• Provider Booklet (PDF)
• Payspan (PDF)
• Quick Reference Guide (PDF)
• Secure Portal (PDF)
• ICD-10 Information
• Taxonomy Reference Guide (PDF)
• Provider Orientation Presentation (PDF)

Quality Improvement/Risk Adjustment

• HEDIS® MY 2021 (PDF)
  
• 2021 QUALITY RATING SYSTEM (QRS) AT-A-GLANCE (PDF)
• Follow-Up After Hospitalization (FUH) - Provider Discharge Checklist (PDF)
• Follow-Up After Hospitalization (FUH) - Mental Illness (PDF)
• Telehealth (TeleBH) - Behavioral Health Care (PDF)
• Telemedicine - Non-Emergency Behavioral Health Services (PDF)
• Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Provider Resource Guide (PDF)
• Optimizing the Impact of the ADD and APP HEDIS® Measures Provider Training (PDF)
  
  • Recorded provider training: available on-demand
• Improve Patient Experience (PDF)
• Continuity of Care Training (PDF)
• Continuity of Care Program Booklet (PDF)
• Specialist Continuity of Care Program (PDF)
• Continunity of Care Program Tiered Incentive Payment Chart (PDF)

Medical Management/ Behavioral Health

• Prior Authorization Guide
• Inpatient Prior Authorization Fax Form (PDF)
• Outpatient Prior Authorization Fax Form (PDF)
• Biopharmacy Outpatient Prior Authorization Fax Form (PDF)
• Prior Authorization Request Form for Non-Specialty Drugs (PDF)
• Clinical Policy: Brand Name Override and Non-Formulary Medications (PDF)
• BH ECHO Provider Training (PDF)
  
• How to Access ECHO Provider Training (PDF)
  

Claims and Claims Payment

• Claim Dispute Form (PDF)
• No Surprises Act Open Negotiation Form (PDF)
  

Quality

• Practice Guidelines (PDF)

New Provider Orientation

• Provider Orientation Presentation (PDF)
• Instructions for Attending a New Provider Orientation
• Provider Orientation 2023 Attestation of Completion