...include: Inappropriate or inconsistent treatment Delay in receipt of care Compromising member health, safety or welfare Having the potential to limit functional abilities on a permanent or long-term basis In...

...ProviderSource Newsletter Summer 2018 ProviderSource Newsletter Ohio Insert Spring 2018 ProviderSource Newsletter Spring 2018 ProviderSource Newsletter Ohio Insert Spring 2018 ProviderSource Newsletter Annual Insert Winter 2017 ProviderSource Newsletter Fall 2017...

...and Human Services VIEW PUBLIC HEALTH EMERENCY INFORMATION Resources Information for Healthcare Professionals Information for Healthcare Professionals Centers for Disease Control and Prevention (CDC) View COVID-19 Information Coronavirus (COVID-19) Partner...

...services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing...

...Providers can view clinical guidelines being used by CareSource at www.myturningpoint-healthcare.com. Providers will initially be asked to “Register for Access”. Upon registration, providers will be able to log into the...

...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...

...partners. In addition, providers are expected to administer patient care in a culturally competent manner. Resources are provided below. Roles and Responsibilities PCP care coordination responsibilities include the following: Assisting...

...Go to https://www.healthplanresources.com to sign in using your NPI* and use the password provided in your Welcome Letter. Office Managers/Administrators: Managing a group of providers? Sign in through the Provider...

...denial include: Claim Disputes If you believe a claim was processed incorrectly due to incomplete, incorrect or unclear information, you should submit a corrected claim through the claim submission process....

...To ensure there is no delay in the review process, be sure to include this medical information when you ask for the exception. Policies CareSource pharmacy policies include drug-specific and...