Administrative Manual - Provider - REG ANH BSH

Administrative Manual

Our manual contains dental and medical policy and procedure information that can be used as a day-to-day reference by our providers and their staff.

Notification of content changes

Updates to manual sections are posted at the beginning of the month in which they occur and a notification is included in our newsletter, The Connection℠. Our newsletter is published in February, April, June, August, October and December. Sign up to receive our newsletters via email. Please review new content promptly to ensure you have the most current information.

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Section

Revision

Change

6/2017

Updated requirements for practice data validation email address

4/2018

Updating to reflect the current process

11/2018

Updated the mail station of the address for submitting Provider Contract Termination Appeals

Effective 4/2020

  • Added Provider Dispute Resolution Process heading
  • Changed “Glossary of Terms” to “Definitions,” replaced references throughout document and alphabetized “Definitions”
  • Removed references to “Binding” or “Non-Binding” review
  • Removed $500 claim dispute requirement
  • Updated External Audit Review section

10/2018

Removed references to ICD-9

2/2020

  • Removed skilled nursing facility Quality Rating section
  • Effective May 1, 2020, adding inpatient concurrent review for acute inpatient medical and behavioral health hospital stays

8/2019

  • Updated hyperlinks throughout
  • Updated name of anti-fraud department to Special Investigations Unit (SIU)

12/2018

Updated to reflect current format and process

2/2020

Added information about Livongo Diabetes Prevention Program (DPP) and Livongo Weight Management

10/2019

Updated Notice of Medicare Non-Coverage (NOMNC) information

Medicare Advantage Compliance Requirements (PDF) Note: Our Medicare Advantage providers must comply with the requirements in this section, in accordance with the Medicare Advantage Provider Compliance Addendum.

2/2020

Updated language in provision 14

2/2019

  • Revised introductory content
  • Added section about medication policies

6/2017

Updated information about The Bulletin

4/2020

Revised program information

6/2018

Updated to reflect current guidelines