Resources

Handbooks and guides

• ADHD toolkit
• Behavioral health provider reference guide (PDF)
• Behavioral health provider toolkit (PDF)
• Claim filing instructions (PDF)
• EPSDT provider toolkit (PDF)
• HEDIS playbook (PDF)
• Marketing guidelines
• NantHealth/Navinet: How to Inquire about an Authorization
• NantHealth/Navient: Authorization Submission
• Provider handbook
• Provider reference guide (PDF)
• TeleECHO™ Integrated Health Care Clinic Participant Guide (PDF)

Administrative

• Account executives (PDF)
• Account executives map (PDF)
• Complaints, disputes, and appeals
• Credentialing
• Disclosure of Ownership and Controlling Interest Statement (PDF)
• Electronic funds, remittance, and data interchange
• Quality perfomance specialist map (PDF)

Administrative Policies

• Provider complaint and dispute processing and resolution policy (PDF)
• Continuity for behavioral healthcare & care coordination with primary care and behavioral health providers (PDF)
• Continuity of care (PDF)
• AmeriHealth Caritas Louisiana enrollee PCP reassignment dispute process (PDF)

Utilization management (UM) policies

• Authorization for out-of-network practitioners and providers (PDF)
• Concurrent review (PDF)
• Continuity of care (PDF)
• Covered benefits and services (PDF)
• Evaluation of new technology (PDF)
• Obstetrical ultrasound policy (PDF)
• Post-service review (PDF)
• Timeliness of UM decisions (PDF)

Clinical resources

• 17P billing and ordering guide (PDF)
• Bright Futures periodicity schedule (EPSDT) (PDF)
• Clinical policies
• Clinical practice guidelines (PDF)
• Flu information
• Hepatitis C algorithm (PDF)
• Hepatitis C guidance (PDF)
• Long Acting Reversible Contraceptives (LARCs) Billing and Ordering Guide (PDF)
• Opioid overdose prevention
• Women's health

Programs and initiatives

• COMPASS program guide (PDF)
• Cultural competency and language services
• HIPAA information
• Integrated health care management (PDF)
• Patient Centered Medical Homes (PCMH)
• Provider Advisory Council (PAC)
• Quality Assessment and Performance Improvement (QAPI) program
• Quality enhancement program (QEP)

Member information

• Member rights and responsibilities
• Medicaid Recipient Insurance Update without Medicare (PDF)
• Medicaid Recipient Insurance Update with Medicare (PDF)