...pre-service appeal. This is considered a member appeal and will be resolved within 30 days plus any extension, if applicable, for a standard appeal. See ‘Extending an Appeal” for more...

...must obtain our prior authorization. When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance...

...April 2019 04/12/2019 Statewide Hepatitis A Outbreak Information 04/12/2019 Applied Behavior Analysis Rates and Pricing 04/04/2019 Policy Updates April 2019 04/01/2019 Enhancements to Delivery and Newborn Notifications – UPDATE 03/28/2019...

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...and meets regulatory and accrediting agency compliance, including: All federal requirements as outlined in 42 CFR Part 438, Managed Care Healthcare Effectiveness Data and Information Set (HEDIS®) compliance audits and...

...all providers, including providers with a single case agreement (SCA), are active provider in ODM’s PNM system for the applicable service. Out-of-network providers must obtain an SCA for payment for...

...the care you need. You can learn more about our Access Plan by visiting www.caresource.com/WV/AccessPlan. Your Primary Care Provider (PCP) You must choose a PCP who is a network provider....

...is unknown, contact Provider Services at 1-800-488-0134. Error Number: 677 Error Description: Rendering National Provider Identifier (NPI) not affiliated to the billing agencies How to Fix: Rendering provider on the...

...Authorization Request Form Specialty Pharmacy Prior Authorization Form Spinal Muscular Atrophy (SMA) Prior Authorization Provider Form T Testosterone Prior Auth Form Request Form Topical Agent Prior Authorization Request Form Tzield...

...address and the password of your choice to complete training and manage accounts for all providers in your Tax Identification Number (TIN). *Office Managers/Administrators and providers without an NPI number...