Policies, Guidelines and Manuals
We are committed to supporting you in providing quality care and services to the members in our network. Here, you will find information for assessing coverage options, guidelines for clinical Utilization Management (UM), practice policies and support for delivering benefits to our members.
Our provider manual provides key administrative information, including the quality improvement program, the UM program, quality standards for participation, claims appeals, and reimbursement and administration policies.
- View or download the provider manual
- Medicare Risk Adjustment Provider Documentation and Coding Guide
Medical Policies and Clinical UM Guidelines
Medical Policies address the medical necessity of new services or procedures and new applications of existing services or procedures. Clinical UM Guidelines focus on detailed selection criteria, goal length of stay and location for generally accepted technologies or services.