Provider Manual definition

Provider Manual means a working document, including but not limited to BCBSM published bulletins and provider notices, that provide specific guidelines and direction by which providers may meet their contractual responsibility as described in this Agreement. Provider Manuals are published on web-DENIS.
Provider Manual means the DAVIS Vision Care Plan Provider Manual, as amended from time to time by DAVIS.
Provider Manual means the interpretive document or documents issued by the office to providers to inform them of their obligations under Medicaid to which they must conform to retain their provider status and receive payment for appropriate services, and to provide them essential information for understanding Medicaid as it relates to the services for which they are qualified to provide under the state statutes.

Examples of Provider Manual in a sentence

  • When the Medi-Cal Provider Manual outlines immunization criteria less restrictive than ACIP criteria, Providers are to administer immunizations in accordance with the less restrictive Medi-Cal Provider Manual criteria.7 DEFINITION: A.

  • Supported employment performance-based job development (SE-JD) was added to OOD’s VR Fee Schedule (Provider Manual) in 2017 and the service rate was most recently updated in October 2023.

  • The VR Fee Schedule (Provider Manual) removed the CESP requirement for Tier III (retention) portion of Supported Employment Job Development and allowed staff who are Certified Rehabilitation Counselors (CRC) to provide this service without CESP certification.

  • MCPs are required to cover all medically necessary major organ transplants (MOT) for CCS-eligible members as outlined in the Medi-Cal Provider Manual, including all updates and amendments to the manual.33 The MCP must refer CCS-eligible members to a CCS-approved SCC for an evaluation within 72 hours of the member’s PCP or specialist identifying the CCS-eligible member as a potential candidate for a MOT.

  • When the Member responds affirmatively to the alcohol pre-screen question on the SHA, the PCP must conduct screening for unhealth alcohol and drug use using validated screening tools, including but not limited to: 16 Title 17 California Code of Regulations (CCR) § 37100 17 DHCS Medi-Cal Provider Manual, Evaluation and Management 18 DHCS APL 21-014 Supersedes APL 18-014, “Alcohol and Drug Screening, Assessment, Brief Interventions and Referral to Treatment” 19 Ibid.

More Definitions of Provider Manual

Provider Manual means the current Internet online version of the official STATE publication, entitled “Minnesota Health Care Programs Provider Manual.”
Provider Manual means the OHCA BH Provider Billing Manual.
Provider Manual means the manual developed by ADMINISTRATOR to describe the specific services to be performed by CONTRACTOR. The TUPP Provider Manual provides guidance, goals, objectives, terminology, and evaluation components.
Provider Manual means the provider manual and any billing manuals, adopted by Company or Payor which include, without limitation, requirements relating to utilization management, quality management, grievances and appeals, and Product-specific, Payor-specific and State-specific requirements, as may be amended from time to time by Company or Payor.
Provider Manual means the compilation of policies and procedures, rules and regulations which are developed by a Payer which are applicable to KYOne HP, Participants, and/or Provider/Supplier under an applicable Payer Agreement.
Provider Manual means HCT’s manual (as modified from time to time) which is available online at and which contains those operating policies, standards, and procedures, including, but not limited to, HCT’s requirements for claims submission and payment, credentialing/re-credentialing, utilization review/management, disease and case management, quality assurance/improvement, advance directives, Member rights, grievances and appeals, which are pertinent to this Agreement.