2014 emblem health provider manual 2017

This manual applies to all emblemhealth plans and is an extension of your provider agreement. Pharmacy program and billing policy and other pharmacy related information can be found in the nys mmis pharmacy provider manual and the departments medicaid update. Provider support manual 2014 to 2015 version 2 january 2015 page 6 of 96 section 1. About the harp program a health and recovery plan harp is a special needs plan that focuses on adults with significant behavioral health needs. In 2017, the prime network expands into connecticut leveraging connecticares. Connecticare, based in connecticut, is a subsidiary of emblemhealth. Bridge gives members access to a combination of our existing hip insurance company of new york hipic prime network, group health incorporated ghi.

Behavioral health policy and procedure manual for providers. Information in our guidelines comes from medical expert organizations, such as the american academy of pediatrics, the us department of health and human services, the advisory committee on immunization practices and the centers for. Visit regularly and stay informed behavioral health beacon options. This provider directory includes participating providers in all specialties. Utilization management preauthorization supplemental list.

It helps you as the provider by eliminating the need to handwrite most prescriptions. This manual details our referral process, quality standards, credentialing and reimbursement process. It is not medical advice and should not be substituted for regular consultation with your health care provider. A large part of quality health care delivery is treating the whole patient and not just the medical condition. Dont miss important alerts, notices, and coverage updates. To address issues with online provider directories, cms strengthened existing subregulatory guidance and communicated concerns about and expectations for provider directories via a health plan management system hpms memo, as well as in the contract year cy 2016 and cy 2017 call letters.

If the member calls, he or she will be asked to have the provider contact emblemhealth to arrange for the interpreter. Once signed in, look for the option on the lefthand navigation bar. Emblemhealth coverage for physician assistant services. Clinical management of neuropsychiatric symptoms of huntington disease. The provider manuals are updated quarterly throughout each fiscal year july june, and are posted one month prior to the effective date. Epoppo or ghi is listed as the primary insurer, you may submit a benefit extension request from our secure provider web site at. It also details best practices for interacting with our plans and helping our members navigate their health care. Depending on family size and income, a person may even qualify for help to pay their monthly premium. This manual applies to all emblemhealth, ghi, hip, hipic and vytra plans, and it replaces all provider manuals published before november 2009. If you have any concerns about your health, please contact your health care providers office.

Michigan department of community health medicaid provider manual, medical supplier, sec. This manual serves as a resource to practitionersproviders and outlines operations for aetna better health of west virginia. Please look at your certificate or group contract to find out if a particular service is covered under your benefit plan. Provider reference manual 2017 table of contents section 1. We ask our providers to check our website periodically for updates. We hope you find this information and the enclosed documents useful to your office operation and in serving your patients our members. Aetna better health is not responsible or liable for nonaetna better health content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. Thats why we created claims corner a resource where you will find updated information on claims policy, best practices for coding your claims, changes to regulatorydriven payment methodology and other useful claimsrelated tips. Inoffice testing list to cover all emblemhealth members. Providers are independent and solely responsible to members for the delivery and. Clinical practice guidelines beacon health options. The plan addresses these needs through the integration of physical health, mental health, and substance use services. Health education in disease prevention, exercise, and healthy living practices the following listed services are generally considered primary care services.

Emblemhealth providers myemblemhealth logout of myemblemhealth. Providers, members or their designee can contact the customer service department via phone at 16464476534 or teletypewriter ttytdd at 18008749426 to request a sign language interpreter for a provider appointment. For hip providers, this is your provider number directory number. This manual will assist the provider in understanding the specific policies, procedures and protocols of the health insurance marketplace plan to deliver and manage health care for members.

Primary care provider, behavioral health provider, maternity, and specialist office wait times previously scheduled appointment no more than 1 hour from scheduled appointment. This chapter contains contact information for parties within emblemhealth, our delegated relationships and other external resources. The american telemedicine association defines telemedicine as the use of medical information exchanged from one site to another via electronic communications to improve a patients clinical health status. Expertbased consensus guidelines on agitation, anxiety, apathy, psychosis and sleep disorders. Audits involving medicare demand billing and overpayments involving dual eli. The individualised learner record, or ilr as it is usually known, is a collection of data about learners and their learning that is. Confidential page 2 of 11 312017 welcome, congratulations, you are a provider in the intergroup network. Please use the search function to find what you are looking for within our provider manual. Emblemhealth understands that getting your claims paid quickly and accurately matters to you. This manual serves as an administrative guide outlining beacons policies and procedures governing. Your specific benefit plan may not cover all services given by participating providers. Emblemhealth preventive care screening services coverage. Guidelines for telemedicine policies and procedures.

About this provider manual this behavioral health provider policy and procedure manual hereinafter, the manual is a legal document incorporated by reference as part of each providers provider services agreement psa with beacon. We are pleased to have you as a participating provider in our medicareapproved health. The health insurance marketplace is an online shopping mall of healthcare plans. Through connecticares website, you will have access to connecticares.

Ambetter offers affordable health care coverage for individuals and families. For ghi users this is either your taxid or provider number. Any information provided on this website is for informational purposes only. Emblemhealth coverage for nurse practitioner services. Beacon health options provider manual the harp program 2 1. Links to various aetna better health and nonaetna better health sites are provided for your convenience. All other members for all other members, medicalsurgical supplies are covered as specified under the medical benefit with the participating vendor. How to use this manual this provider manual is designed to be a. The meridian choice provider manual is designed specifically for meridian choice providers. Providers can contact emblemhealth at 18778423625 for a complete listing of items covered by the chplus program. Sensitivity to differing cultural influences, beliefs and backgrounds, can improve a providers relat. The intergroup network unites doctors, hospitals and allied professionals with businesses, labor organizations, third party administrators and insurers in a partnership for quality. Revised 12152014 21 washington county health and human services wchhs mental health program policy and procedure. Unitedhealthcares home for care provider information with 247 access to link selfservice tools, medical policies, news bulletins, and great resources to support administrative tasks including eligibility, claims and prior authorizations.

Dentaquest places great emphasis on the wellness of its members. Find out whats going on at emblemhealth and in the world of health care. It includes detailed information about your administrative responsibilities, and contractual and regulatory obligations. Current manuals are available at provider manual for community behavioral health providers, 01112 and provider manuals for community developmental disabilities providers, 021201. Meridian medicaid provider manual 2015 iowa revised 72015 i 2015 provider manual revised. Find a seminar or webinar claims information view provider manual clinical guidelines. Through the manual, practitioners and providers should be able to identify information on the majority of.