Materiales de referencia

• 2022 Provider & Billing Manual (PDF)
• 2020 Provider & Billing Manual (PDF)
• 2021 Provider & Billing Manual (PDF)
  
• Quick Reference Guide (PDF)
• Prior Authorization Guide (PDF)
• Secure Portal (PDF)
• Payspan (PDF)
• ICD-10 Information
• My Health Pays Provider Educational Flyer (PDF)
• Waiting Room Quick Guide Card (PDF)

Administración médica

• Pre-Auth Needed?
• Inpatient Prior Authorization Fax Form (PDF)
• Outpatient Prior Authorization Fax Form (PDF)
• Authorization and Coverage Complaints
• Durable Medical Equipment (DME) Form (PDF)
  
• Breast Pump Request Form (PDF)
• Sterilization Consent Form (PDF)
• Biopharmacy/Buy-bill Prior Authorization Form (PDF)

Salud del comportamiento

• Electroconvulsive Therapy (ECT) Authorization Request Form (PDF)
• OTR Completion Tip Sheet (PDF)
• Psychological or Neuropsych Testing Authorization Request Form (PDF)
• Applied Behavioral Analysis Prior Authorization Request Form (PDF)
• Outpatient/ Inpatient Behavioral Health Service Authorization Request Form (PDF)
  

Vista

• Opticare Provider Manual (PDF)

Servicios de oftalmología

• Pre-Authorization Request Form (PDF)

Reclamaciones y pago de reclamaciones

• Request for Out of Network Payment Evaluation (PDF)
• Claim Reconsideration and Dispute Form (PDF)
• Claims and Payment Decision Tree (PDF)
• Claims Trend Form (PDF)
• Provider Claims FAQ (PDF)

Calidad

• Quality Improvement (QI)
• Practice Guidelines (PDF)

 Recursos para la reconsideración

• Reconsideration Grid (PDF)
• Change in Condition (PDF)
  
• Claim Reconsideration and Dispute Form (PDF)
  
• Re-Review Request Form (PDF)

Otro

• Member Rights & Responsibilities (PDF)
• Advance Directives and POLST