Common use of Provider Handbooks Clause in Contracts

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. 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.. • Description of the Demonstration; • Practice protocols for the Demonstration; • Other Provider responsibilities pertaining to the Demonstration; • Coding requirements pertaining to the Demonstration; • Prior Authorization, Pre-Certification, and Referral procedures pertaining to the Demonstration; • P4HB Participants 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. 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 specialrequirements 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.. • Description of the Demonstration; • Practice protocols for the Demonstration; • Other Provider responsibilities pertaining to the Demonstration; • Coding requirements pertaining to the Demonstration; • Prior Authorization, Pre-Certification, and Referral procedures pertaining to the Demonstration; • P4HB Participants 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. 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.. · Description of the Demonstration; · Practice protocols for the Demonstration; · Other Provider responsibilities pertaining to the Demonstration; · Coding requirements pertaining to the Demonstration; · Prior Authorization, Pre-Certification, and Referral procedures pertaining to the Demonstration; · P4HB Participants 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. 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 specialrequirements 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.. · Description of the Demonstration; · Practice protocols for the Demonstration; · Other Provider responsibilities pertaining to the Demonstration; · Coding requirements pertaining to the Demonstration; · Prior Authorization, Pre-Certification, and Referral procedures pertaining to the Demonstration; · P4HB Participants 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.