Provider Manual
The Community Health Plan Provider Manual provides an overview of Community Health Plan. It links to forms, procedures, and references to help you provide better service.
For tools and information, see:
The Provider Manual serve as a reference for you as a provider and contains content such as:
- Introduction and who we are
- Directory of services and contacts
- Access to care standards
- Credentialing
- Access to records and enrollee health information
- Medical record documentation standards and policies
- Reporting changes in provider status
- Eligibility
- PCP assignment
- Disenrollment
- ID cards
- Enrollee benefits
- Children First™
- Enrollee rights and responsibilities
- Interpreter services
- Billing and claims payment
- Appeals
- DRG and fee schedule disputes
- Utilization management
- Case management
- Member Review and Intervention Program (MRIP)
- Disease management
- Clinical care criteria
- Transition of care
- Pharmacy management
- Quality program
If you have questions regarding any policies and procedures explained in this manual, please contact our Provider Relations team: Phone 1-800-440-1561 toll free or fax 206-613-5018.
Provider Manual
- Introduction
- Policies and Procedures
- Forms and Tools
- References and Other
- State Programs Eligibility
- Medical Care Services replaces Disability Lifeline/GA-U
- Status Reporting, Program Counties, Medicare Providers
- Medical Records
- Directory of Services and Contacts
- Provider Relations
- Care Standards and Credentialing
- Changes to the Prior Authorization List and Utilization Guidelines for 2012
- Enrollee Benefits
- Medicare Advantage Eligibility
- Identification Cards
- Enrollee Rights and Responsibilities
- Interpreter Services
- Billing and Claims Payment
- Grievances and Appeals
- Care Management
- Utilization Management
- Case Management
- Member Review and Intervention Program (MRIP)
- Disease Management Program
- Clinical Care Criteria, Transition of Care
- Pharmacy Management
- Quality Program