Provider Handbooks Clause Samples
The 'Provider Handbooks' clause establishes that the provider must adhere to guidelines, procedures, or standards set forth in specific handbooks or manuals referenced by the agreement. These handbooks typically outline operational requirements, service protocols, or compliance obligations that the provider is expected to follow during the term of the contract. By referencing these handbooks, the clause ensures that both parties have a clear and consistent understanding of the provider's duties, reducing ambiguity and helping to maintain service quality and regulatory compliance.
Provider Handbooks. 4.9.2.1 The Contractor shall issue a Provider Handbook to all network Providers at the time the Provider Contract is signed. The Contractor may choose not to distribute the Provider Handbook via mail, provided it submits a written notification to all Providers that explains how to obtain the Provider Handbook from the CMO’s Web site. This notification shall also detail how the Provider can request a hard copy from the CMO at no charge to the Provider. All Provider Handbooks and bulletins shall be in compliance with State and federal laws. The Provider Handbook shall serve as a source of information regarding GF Covered Services, policies and procedures, statutes, regulations, telephone access and special requirements to ensure all Contract requirements are being met. At a minimum, the Provider Handbook shall include the following information: · Description of the GF; · Covered Services; · Emergency Service responsibilities; · Health Check/EPSDT program services and standards; · Policies and procedures of the Provider complaint system; · Information on the Member Grievance System, including the Member’s right to a State Administrative Law Hearing, the timeframes and requirements, the availability of assistance in filing, the toll-free numbers and the Member’s right to request continuation of Benefits while utilizing the Grievance System; · Medical Necessity standards and practice guidelines; · Practice protocols, including guidelines pertaining to the treatment of chronic and complex Conditions; · PCP responsibilities; · Other Provider or Subcontractor responsibilities; · Prior Authorization, Pre-Certification, and Referral procedures; · Protocol for Encounter Data element reporting/records; · Medical Records standard; · Claims submission protocols and standards, including instructions and all information necessary for a clean or complete Claim; · Payment policies; · The Contractor’s Cultural Competency Plan; and · Member rights and responsibilities.
4.9.2.2 The Contractor shall disseminate bulletins as needed to incorporate any needed changes to the Provider Handbook.
4.9.2.3 The Contractor shall submit the Provider Handbook to DCH for review and approval and as updated. Any updates or revisions shall be submitted to DCH for review and approval at least 30 days prior to distribution.
Provider Handbooks. The Health Plan shall develop and issue a Provider Handbook to all Providers at the time the Provider Contract is signed. The Health Plan may choose not to distribute the Provider Handbook via Surface Mail, provided it submits a written notification to all Providers that explains how to obtain the Provider Handbook from the Health Plan’s website. This notification shall also detail how the Provider can request a hard-copy from the Health Plan at no charge to the Provider. All Provider Handbooks and bulletins shall be in compliance with State and federal laws. The Provider Handbook shall serve as a source of information regarding Health Plan Covered Services, policies and procedures, statutes, regulations, telephone access and special requirements to ensure all Contract requirements are met. At a minimum, the Provider Handbook shall include the following information:
Provider Handbooks. 4.9.2.1 The Contractor shall issue a Provider Handbook to all network Providers at the time the Provider Contract is signed. The Contractor may choose not to distribute the Provider Handbook via mail, provided it submits a written notification to all Providers that explains how to obtain the Provider Handbook from the CMO’s Web site. This notification shall also detail how the Provider can request a hard-copy from the CMO at no charge to the Provider. All Provider Handbooks and bulletins shall be in compliance with State and federal laws. The Provider Handbook shall serve as a source of information regarding GHF Covered Services, policies and procedures, statutes, regulations, telephone access and special requirements to ensure all Contract requirements are being met. At a minimum the Provider Handbook shall include the following information:
4.9.2.1.1 Description of the GHF;
4.9.2.1.2 Covered Services;
4.9.2.1.3 Emergency Service responsibilities;
4.9.2.1.4 Health Check/EPSDT program services and standards;
4.9.2.1.5 Policies and procedures of the Provider complaint system;
4.9.2.1.6 Information on the Member Grievance System, including the Member’s right to a State Administrative Law Hearing, the timeframes and requirements, the availability of assistance in filing, the toll-free numbers and the Member’s right to request continuation of Benefits while utilizing the Grievance System;
4.9.2.1.7 Medical Necessity standards and practice guidelines;
4.9.2.1.8 Practice protocols, including guidelines pertaining to the treatment of chronic and complex Conditions;
Provider Handbooks. The provider agrees to comply with the applicable terms, conditions, and restrictions that are set forth in the internet-based Family Care, Family Care Partnership, Program of All-Inclusive Care for the Elderly (PACE), or IRIS Online Handbooks, bulletins, Adult Long-Term Care Updates, and other communications regarding changes in state or federal law, policy, reimbursement rates and formulas, departmental interpretation, procedural directives such as billing and prior authorization procedures, and specific reimbursement changes, which are issued by DHS under Wis. Admin. Code § DHS 108.02(2) and (4). The Online Handbook, bulletins, and Adult Long-Term Care Updates are available to the provider through the ForwardHealth Portal at ▇▇▇▇▇://▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇.▇▇▇. The omission of any applicable term, condition, or restriction from this section does not excuse the provider from complying with that term, condition, or restriction.
Provider Handbooks. 4.9.2.1 The Contractor shall issue a Provider Handbook to all network Providers at the time the Provider Contract is signed. The Contractor may choose not to distribute the Provider Handbook via mail, provided it submits a written notification to all Providers that explains how to obtain the Provider Handbook from the CMO’s Web site. This notification shall also detail how the Provider can request a hard copy from the CMO at no charge to the Provider. All Provider Handbooks and bulletins shall be in compliance with State and federal laws. The Provider Handbook shall serve as a source of information regarding GF Covered Services, policies and procedures, statutes, regulations, telephone access and special requirements to ensure all Contract requirements are being met. At a minimum, the Provider Handbook shall include the following information: