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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