2012 Provider Manual

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Table of Contents

SECTION TOPIC
 

Introduction Letter

 

Table of Contents

1

About the Plan and Compliance

2

Providers' Right and Responsibilities

3

Provider Relations

4

Provider Participation

5

Primary Care

6

Specialty Care

7

OB-GYN and Family Planning

8

Emergency and Urgent Care

9

Behavioral Health

10

Coordination of Medical Care

11

Billing and Reimbursement

12

Care Management and Appeals

13

Dental Provider

14

Ancillary Providers

15

Transportation Guidelines

16

QAPIP

17

QARR

18

External Monitoring and Evaluation

19

Public Health Reporting Requirements and Intervention

20

Practice Guidelines

21

Members' Right and Responsibilities

22

HIV/AIDS

22

HIV/AIDS FLOW CHART

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Appendices

 

# FORM/POLICY/GUIDELINE
 

Appendix Index

1

Phone & Contact Summary

2

Benefits Summary

3

Step Therapy

4a

CHP Formulary

4b

Medicaid Managed Care and Family Health Plus Formulary

5

NPI Application

6a

Prior Authorization Form Sample

6b

Prior Authorization Form for Advanced Imaging

6c

Cosmetic Surgery Codes that Require Prior Authorization

7

IVR Instruction Update

8

Practice Information Change Form

9

Medical Records Review Tool – Users Guidelines

10a

Transportation Reimbursement Form 1

10b

Transportation Reimbursement Form 2

11

CAGE Test

12

TWEAK Test

13

Mini Mental State Examination

14

PHQ-9

15

Child Teen Health Program

16

AMA GAPS

17

Preventive Care Guidelines

18

Medicaid Prenatal Care Standards

19

Appointment Standards

20

24 Hour Access Contact System

21a

AIDS Institute Order Form

21b

AIDS Institute Consumer Educational Order Form

21c

AIDS Institute Designated Centers

22

Prenatal Care Notification Form

23a

Universal Reporting Forms

23b

New York State Department of Health Communicable Disease Reporting Requirements

23c

Communicable Diseases Reporting Form

24

Incident Report Form

25

Asthma Action Plan

26

Asthma Care Guideline

27

Adult Diabetes Care Guidelines

28

Smoking Cessation Guideline

29

Ambulatory Surgical Procedures Requiring Precertification

30

QARR Codes

31

NHP SHP Benefit Authorization Guide

32

Preventing Colorectal Cancer

33a

Lead Poisoning Brochure

33b

Lead Poisoning: Prevention, Identification, and Management

33c

NYS Regulations for Lead Poisoning Prevention and Control

34a

School Admission Immunization Requirements

34b

NYS Department of Health Adult Immunization Schedule

35

Hypertension Guidelines

36

Treating Tobacco Addiction

37

Rapid HIV Testing

38

Influenza: Prevention and Control

39

NHP CM Referral Form

40

NHP Compliance Program

41

Sample of Letters

42

Member Release of PHI

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