Bravo Marine Heating System Bh 0133 Users Manual

2015-02-02

: Bravo Bravo-Bravo-Marine-Heating-System-Bh-0133-Users-Manual-484987 bravo-bravo-marine-heating-system-bh-0133-users-manual-484987 bravo pdf

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Live life well.2008 Provider ManualTexasBH-0133 Revised January 2008
1 TABLE OF CONTENTS QUICK REFERENCE GUIDE .........................................................................................................................................................4  MEMBER INFORMATION  ............................................................................................................................................................ 6 Member Eligibility .................................................................................................................................................................6 Eligibility Verification............................................................................................................................................................6 Member Hold Harmless..........................................................................................................................................................8 Member Confidentiality .........................................................................................................................................................8 Member Rights and Responsibilities ......................................................................................................................................9 Advance Medical Directives...................................................................................................................................................13 Benefits and Services..............................................................................................................................................................13  PROVIDER INFORMATION ..........................................................................................................................................................13 Role of the Primary Care Physician (PCP).............................................................................................................................13 Role of the Specialist Physician .............................................................................................................................................14 Communication between Providers........................................................................................................................................14 Provider Marketing Guidelines...............................................................................................................................................14  PROVIDER CREDENTIALING AND PARTICIPATION ........................................................................................................... 15  PROVIDER & ALLIED HEALTH PRACTITIONERS CREDENTIALING CRITERIA ........................................................ 15 Required Information .............................................................................................................................................................15 Credentials Criteria................................................................................................................................................................. 16 Additional Requirements........................................................................................................................................................19 Initial Credentialing Office Site Reviews...............................................................................................................................19 Provider Re-Credentialing......................................................................................................................................................20 Practitioner’s Rights ...............................................................................................................................................................20  PROVIDERS DESIGNATED AS PRIMARY CARE PHYSICIANS............................................................................................21  CHANGES IN ADMINISTRATIVE, MEDICAL AND/OR REIMBURSEMENT POLICIES..................................................21  NOTIFICATION REQUIREMENTS FOR PROVIDERS............................................................................................................. 21  CLOSING PATIENT PANELS......................................................................................................................................................... 22  PROVIDER ACCESS AND AVAILABILITY STANDARDS ....................................................................................................... 22  CLAIMS SUBMISSION  ................................................................................................................................................................... 23 Professional Claims ................................................................................................................................................................23 Institutional Claims.................................................................................................................................................................24 Participating Provider Claim Reconsideration Process .......................................................................................................... 25 Claim Adjustment Reason Codes ...........................................................................................................................................26  NATIONAL PROVIDER IDENTIFIER (NPI)................................................................................................................................ 31  HIERARCHICAL CONDITION CATEGORIES (HCC) .............................................................................................................. 33  SAMPLE EXPLANATION OF BENEFITS (EOB) STATEMENT AND PAYMENT CHECK ................................................34

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