2008 Provider Manual
Table of Contents
Overview of Suffolk Health Plan
Claim, Encounter & Referral Form Submission
Changing Your Practice Address
Provider Relations
Verifying Member Eligibility
Member Enrollment Process
Selection/Change of the Primary Care Provider
The Role of the Primary Care Provider (PCP)
The Role of the Referral Specialist Provider
The Role of the OB/GYN Provider
Primary Care Services
Referral Specialist Services
Member Services
Authorization Procedures
Hospital Services
Other Procedures
Quality Assessment Performance Improvement Program
SHP Case Management Program
Practice Guidelines
Utilization Management Program
Action Appeals Policy
Corrective Action Process
Credentialing / Recredentialing
Provider Participation Appeal Process
Medicaid Scope of Services
Child Health Plus Scope of Services
Family Health Plus Scope of Services
Provider Network and Ancillary Services
Quality Assurance Reporting Requirements
2008 Provider Manual Appendices
Appendix Table of Contents
NPI Application
Practice Change Form
Referral Voucher Form
Ambulatory Surgery Procedures Requiring Precertification
SHP CHP Formulary
CAGE Test
TWEAK Test
Mini- Mental State Exam
Medical Record Standards
Incident Report Form
SHP Medicaid Benefits Package
AIDS Institute Order Form
PCP 24 Hours Coverage Notice
OB 24 Hours Coverage Notice
Appointment Scheduling Standards
PCP Guidelines
SHP Benefit Authorization and Referral Guide
Asthma Action Plan
Asthma Guidelines
Preventive Care Guidelines
Smoking Cessation Guidelines
Diabetes Guidelines Tool
Diabetes Guidelines for Adults
Compliance Summary for Provider Manual
Communicable Diseases Reporting Requirements
SHP Phone Contact Reference
SHP UM Claim Procedures Summary
Provider Manual SHP BENEFITS Aug 2005
SHP Member ID Card MCD FHP Finals
SHP Member ID Card CHP Finals
Prenatal Care Notification and Home Care Authorization Form
