Provider Manual

Provider Manual
Chapter 1	Introduction to ACA StandardHealth with Health Choice Exhibit 1-1 Provider Escalation Notice
Chapter 2	Member Eligibility and Member Services
Chapter 3	Provider Responsibility
Chapter 4	Cultural Competency
Chapter 5	Quality Management Exhibit 5.1 Care Management Referral Form
Chapter 6	Authorizations and Notifications Exhibit 6.2 Medical Services and Behavioral Health Prior Authorization Form PA and Continued Stay Review Form for Psychiatric Hospitals and Sub-Acute Facilities BHIF, BHRF, TFC, and SUD BHRF Prior Authorization and Continued Stay Request Form Notification of Admission, Transfer and Discharge for Out of Home Placements
Chapter 7	General Billing Rules
Chapter 8	Billing on the CMS 1500 Claim Form
Chapter 9	Billing on the UB Claim Form
Chapter 10	Billing on the ADA Claim Form
Chapter 11	Claims Processing
Chapter 12	Correcting Claim Errors
Chapter 13	Understanding the Remittance Advice Exhibit 13.1 Medical Remittance Advice Exhibit 13.2 Dental Remittance Advice Exhibit 13.3 Remittance Denial Codes
Chapter 14	Medicare and Other Insurance Liability
Chapter 15	Claim Disputes, Member Appeals, and Member Grievances
Chapter 16	Maternal Health and Children’s Services Exhibit 16.4 Newborn Reporting Form Exhibit 16.10 Maternal Risk Assessment
Chapter 17	Pharmacy and Drug Formulary Prescription Medication Formulary
Chapter 18	Hospital Services PA and Continued Stay Review Form for Psychiatric Hospitals and Sub-Acute Facilities BHIF, BHRF, TFC Prior Authorization and Continued Stay Request Form Notification of Admission, Transfer and Discharge for Out of Home Placements Northern AZ ED Reporting
Chapter 19	Oral Health Services Exhibit 19.1 Dental Specialty Request form
Chapter 20	Care Management

Providers

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