Resources
Handbooks and guides
- Behavioral health provider reference guide (PDF)
- Behavioral health provider toolkit (PDF)
- Claim filing instructions (PDF)
- EPSDT provider toolkit (PDF)
- HEDIS playbook (PDF)
- Marketing guidelines
- Provider handbook
- Provider reference guide (PDF)
- Quick-Start Guide: ZeOmega® Jiva (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)
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)