Providers

Provider Manual

Last updated on April 4th, 2022 at 09:31 am

The provider manual provides important information about Health Choice Pathway.

 

Chapter 1

Introduction to Health Choice Pathway
Exhibit 1-1 Provider Escalation Notice
Chapter 2

Member Services
Exhibit 2.1 Member Dual ID Card
Exhibit 2.2 Medicare ID Card
Chapter 3

Provider Responsibility
Chapter 4

Cultural Competency
Chapter 5

Quality Management
Chapter 6

Medical Authorizations and Referrals
Exhibit 3-6.12 Maternal Risk Assessment Form
Exhibit 5-1 Case Management Referral Form
Prior Authorization Guidelines effective 4/1/2022
Prior Authorization Guidelines effective 10/1/2021
Prior Authorization Guidelines effective 4/6/2021
Prior Authorization Guidelines effective 1/1/2021
Prior Authorization Guidelines effective 10/1/2020
Prior Authorization Guidelines effective 7/1/2020
Prior Authorization Guidelines effective 3/27/2020
Exhibit 6-2 Medical Services Prior Authorization Form
Exhibit 17-1 Pharmacy Medication Prior Authorization Form
Chapter 7

Inpatient & Outpatient Hospital Care
Chapter 8

Coordination of Benefits or Other Insurance Liability
Chapter 9

Grievance, Appeals, Claim Resubmission and Reconsiderations
Chapter 10

Drug Formulary
Exhibit 17-1 Pharmacy Medication Prior Authorization Form
Chapter 11

Transplant Services
Chapter 12

Covered Benefits
Exhibit 12-1 Supplemental Benefit Comparison Chart
Chapter 13

Care Management

 

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Last updated on February 2nd, 2021 at 05:34 am

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