Provider Policy and Procedures Manual Sample Clauses
The Provider Policy and Procedures Manual clause establishes that the provider must adhere to a set of documented policies and procedures as a condition of their participation or service delivery. This typically means the provider is required to follow operational guidelines, compliance standards, and administrative processes outlined in a manual supplied by the contracting party or regulatory body. By referencing this manual, the clause ensures that all providers operate consistently and in accordance with established expectations, thereby reducing misunderstandings and promoting uniformity in service delivery.
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Provider Policy and Procedures Manual. The Contractor shall provide and maintain a Provider Policies and Procedures Manual for use by the Contractor’s network of Hoosier Healthwise providers. The Provider Policies and Procedures Manual shall be available both electronically and in hard copy (upon request) to all network providers, without cost, when they are initially enrolled, when there are any chances in policies and procedures, and upon a provider’s request. The Provider Policies and Procedures Manual shall include, at minimum, the following information, separately stated for each State lines of business as appropriate: Benefits and limitations; Claims filing instructions; Criteria and process to use when requesting prior authorizations; Definition and requirements pertaining to urgent and emergent care; Participants’ rights; Providers’ rights for advising or advocating on behalf of his or her patient; Provider non-discrimination information; Policies and procedures for grievances and appeals in accordance with 42 CFR 438.414; Frequently asked questions and answers; and Contractor, FSSA and OMPP contact information such as addresses and phone numbers. The Contractor shall offer Provider Policies and Procedures Manual training to all network providers when they are initially enrolled in the network, whenever there are changes in policies or procedures, and upon a provider’s request. Updates or changes in operation that require revisions to the Provider Policies and Procedures Manual shall be submitted to OMPP for review and approval in accordance with the requirements outlined in Section 5.7.1.
Provider Policy and Procedures Manual. The Contractor shall provide and maintain a Provider Policies and Procedures Manual for ovider Policies and Procedures Manual shall be available both electronically and in hard copy (upon request) to all network providers, without cost, when they are initially enrolled, when there are any chances in policies and procedures, and upon a provide Policies and Procedures Manual shall include, at minimum, the following information, separately stated for each State lines of business as appropriate: Benefits and limitations; Claims filing instructions; Definition and requirements pertaining to urgent and emergent care; Provider non-discrimination information; Policies and procedures for grievances and appeals in accordance with 42 CFR 438.414; Frequently asked questions and answers; and Contractor, FSSA and OMPP contact information such as addresses and phone numbers. The Contractor shall offer Provider Policies and Procedures Manual training to all network providers when they are initially enrolled in the network, whenever there are operation that require revisions to the Provider Policies and Procedures Manual shall be submitted to OMPP for review and approval in accordance with the requirements outlined in Section 5.7.1.