Provider Manual. The Provider Manual shall be a comprehensive online reference tool for the Provider and staff regarding, but not limited to, administrative, prior authorization, and referral processes, claims and encounter submission processes, continuity of care requirements, and plan benefits. The Provider Manual shall also address topics such as clinical practice guidelines, availability and access standards, care management programs and Enrollee rights.
Appears in 8 contracts
Samples: www.cms.gov, www.cms.gov, www.cms.gov
Provider Manual. The Provider Manual shall be a comprehensive online reference tool for the Provider and staff regarding, but not limited to, administrative, prior authorization, and referral Referral processes, claims and encounter Encounter submission processes, continuity of care requirements, and plan benefits. The Provider Manual shall also address topics such as clinical practice guidelines, availability and access standards, care management programs Care Management Programs and Enrollee rights, including Enrollees rights not to be balanced billed. The Contractor must include in the Provider Manual a provision explaining that the Plan may not limit a Provider’s communication with Enrollees as provided in Section 2.8.1.2.2.
Appears in 5 contracts
Samples: License Agreement, clpc.ucsf.edu, dualsdemoadvocacy.org
Provider Manual. The Provider Manual manual shall be a comprehensive online reference tool for the Provider Providers and staff regarding, but not limited to, regarding administrative, prior authorization, and referral Referral processes, ; claims and encounter Encounter submission processes, continuity of care requirements, ; and plan benefits. The Provider Manual manual shall also address topics such as clinical practice guidelines, availability and access standards, care management programs Care Management programs, and Enrollee rights.
Appears in 3 contracts
Samples: Model Contract, Model Contract, Model Contract
Provider Manual. The Provider Manual shall be a comprehensive online reference tool for the Provider and staff regarding, but not limited to, administrative, prior authorization, and referral Referral processes, claims and encounter submission processes, continuity of care requirements, and plan benefits. The Provider Manual shall also address topics such as clinical practice guidelines, availability and access standards, care management programs Care Management Programs and Enrollee rights.
Appears in 3 contracts
Samples: www.illinois.gov, www.justiceinaging.org, www.illinois.gov
Provider Manual. The Provider Manual manual shall be a comprehensive online reference tool for the Provider Providers and staff regardingregarding administrative, but not limited to, administrativeeligibility verification, prior authorization, and referral Referral processes, ; claims and encounter Encounter submission processes, continuity of care requirements, ; Provider claim dispute and authorization dispute processes; Enrollee Grievance and Appeal processes; and plan benefits. The Provider Manual manual shall also address topics such as clinical practice guidelines, availability and access standards, care management programs Care Management and Utilization Review programs, and Enrollee rights.
Appears in 2 contracts
Samples: www.illinois.gov, www.illinois.gov
Provider Manual. The Provider Manual shall be a comprehensive online reference tool for the Provider and staff regarding, but not limited to, administrative, prior authorization, and referral Referral processes, claims and encounter submission processes, continuity of care requirementsclaims, and plan benefits. The Provider Manual shall also address topics such as clinical practice guidelines, availability and access standards, care management programs Disease Management Programs, and Enrollee rights.
Appears in 2 contracts
Samples: www2.illinois.gov, www.illinois.gov
Provider Manual. The Provider Manual shall be a comprehensive online reference tool for the Provider and staff regarding, but not limited to, administrative, prior authorization, and referral Referral processes, claims and encounter Encounter submission processes, continuity of care requirements, and plan benefits. The Provider Manual shall also address topics such as clinical practice guidelines, availability and access standards, care management programs Care Management Programs and Enrollee rights, including Enrollees rights not to be balanced billed. The Contractor must include in the Provider Manual a provision explaining that the Plan may not limit a Provider’s communication with Enrollees as provided in Section 2.8.1.2.3.
Appears in 1 contract
Samples: www.cms.gov