Provider Manual. The Provider Manual shall be a comprehensive online reference tool for the Provider and staff regarding, but not limited to, administrative, prior authorization, and Referral processes, claims and Encounter submission processes, and plan benefits. The Provider Manual shall also address topics such as clinical practice guidelines, availability and access standards, Care Management Programs and Enrollee rights, including Enrollees rights not to be balanced billed. The Contractor must include in the Provider Manual a provision explaining that the Plan may not limit a Provider’s communication with Enrollees as provided in Section 2.8.1.2.2.
Provider Manual. The MCO must develop, distribute and maintain a provider manual. The MCO must submit a copy of the provider manual to BMS by July 1 of each Contract year. In addition, the MCO must document the approval of the provider manual by the MCO Administrator and Medical Director and must maintain documentation that verifies that the provider manual is reviewed at least annually. The MCO must ensure that each provider (individual or group which submits claim and encounter data) is issued a printed or electronic copy of the provider manual during the contracting process with the MCO. The MCO must provide a copy of the provider manual to a provider upon request . When there are program or service site changes, notification will be provided to the affected providers at least thirty calendar days before the intended effective date of the change. The MCO must publish and keep current its provider manual on the MCO website.
Provider Manual. The MCO must develop, distribute, and maintain a provider manual. The MCO must submit a copy of the provider manual to BMS by July 1st of each Contract year. BMS reserves the right to review and approve the MCO’s provider manual. In addition, the MCO must document the approval of the provider manual by the MCO Administrator and Medical Director and must maintain documentation that verifies that the provider manual is reviewed at least annually. The MCO must ensure that each provider (individual or group which submits claim and encounter data) is issued a printed or electronic copy of the provider manual during the contracting process with the MCO. The MCO must provide a copy of the provider manual to a provider upon request. When there are BMS policy or program changes or MCO procedure or service site changes, notification must be sent to the affected providers at least thirty (30) calendar days before the intended effective date of the change. The MCO must publish and keep current its provider manual on the MCO website.
Provider Manual. The Provider Manual shall be a comprehensive online reference tool for the Provider and staff regarding, but not limited to, administrative, prior authorization, and referral processes, claims and encounter submission processes, continuity of care requirements, and plan benefits. The Provider Manual shall also address topics such as clinical practice guidelines, availability and access standards, care management programs and Enrollee rights.
2.9.10.5.1. Except as otherwise required or authorized by CMS, DHCS or by operation of law, ensure that Network Providers receive thirty (30) days advance notice in writing of policy and procedure changes, and maintain a process to provide education and training for Network Providers regarding any changes that may be implemented, prior to the policy and procedure changes taking effect.
Provider Manual. BCBSM will, without charge, supply Provider with BCBSM guidelines and administrative information concerning billing requirements, benefits, utilization management and such other information as may be reasonably necessary for Provider to deliver Covered Services to Members and be paid. As available, BCBSM may provide such information through electronic means via web-DENIS or internet.
Provider Manual. The MCO must customize, distribute, and maintain a provider manual, using ODM-provided template and required model provider manual language. The MCO must submit the provider manual to ODM for review and approval prior to distribution. The MCO must issue bulletins as needed to incorporate any necessary changes to the provider manual and must review the entire provider manual at least annually. The MCO must post the provider manual on its website.
Provider Manual. The Provider Manual supplements and is made a part of and incorporated into this Agreement, and Providers shall comply with the Provider Manual. Health Plan may amend the Provider Manual from time to time upon notice to Provider by posting to Health Plan’s provider website, email or other means of notice permitted by this Agreement, provided that in the case of material revisions to the Provider Manual, Health Plan shall provide notice in accordance with the provisions of this Agreement regarding written notice. Changes to the Provider Manual shall become effective 15 days after such posting or notice, or such other time period required for Health Plan to comply with Laws, Program Requirements or accreditation standards. Providers shall have and maintain systems necessary for access to Health Plan’s provider website, and check for revisions to the Provider Manual from time to time.
Provider Manual. We agree to provide you with access to a Provider Manual, containing current information concerning benefit exclusions and Policies and Procedures, in accordance with
Provider Manual. The written document made available on the Avesis website or provided to the Provider by Avesis that describes the administrative policies and procedures established by Avesis for the provision of Covered Benefits to Members. The Provider Manual may be amended from time to time and the terms of which are hereby expressly incorporated by reference into, and as a part of, this Agreement.
Provider Manual. In Article V. of the Agreement, the following provisions shall be added to the end of Paragraph 5.2:
