[PDF] Health Excel IPA Provider Manual

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Our Physicians

INTRODUCTION

CONTACT Health Excel IPA

Contracted Health Plans:

Claims Correspondence Address:

Claims/Encounter Data:

Claims Mailing Address:

Provider Disputes:

CONTACT Health Excel (cont.)

Provider Services Team

QUALITY IMPROVEMENT

PROGRAM

Our Mission, Vision, and Commitment to Our Members

Program Structure

Objectives

ACCESS TO CARE STANDARDS

Procedures

Commercial & Medicare Non-Emergent Medical Appointment Access Standards Behavioral Health Emergent & Non-Emergent Appointment Access Standards

ACCESS TO CARE STANDARDS

(cont.) Medi-Cal Non-Emergent Medical Appointment Access Standards

Medicare Dental Appointment Access Standards

MEMBER RIGHTS and RESPONSIBILITIES

PURPOSE

POLICY

MEMBER GRIEVANCES/

APPEALS PROCESS

Requesting a Grievance/Appeal

Department of Managed Health Care (DMHC)

MEMBER IDENTIFICATION

(ID) CARDS

Health Plan Insurance Card Samples

Blue Shield

Promise

of California Brand

New Day

Alignment

Health Plan

Imperial

Health Plan

Golden State

Medicare

Health Plan

MEMBER & PHYSICIAN

RESOURCES

MEMBER RESOURCES

PHYSICIAN RESOURCES

ANNUAL PHYSICIAN

COMPLIANCE TRAINING

TRAINING MODULES

CREDENTIALING

Overview

Credentialing Process

Non-Discrimination Policy - Credentialing and Re-Credentialing

CREDENTIALING (cont.)

CREDENTIALING (cont.)

COMPLIANCE PROGRAM

PROSPECT COMPLIANCE PROGRAM

CLAIMS PROCEDURES

CLAIMS PROCEDURES (cont.)

CLAIMS PROCEDURES (cont.)

CLAIMS PROCEDURES (cont.)

CLAIMS PROCEDURES (cont.)

SUBMITTING AUTHORIZATIONS

All routine requests shall be submitted via Aerial Care:

Out-Of-Network Referrals

STAT/Urgent Referral Requests

CLAIMS PROCEDURES (cont.)

PRIOR AUTHORIZATION

REFERRALS

ADDITIONAL RESOURCES

AUTO-APPROVAL GUIDE

AUTO-APPROVAL GUIDE

TREAMENT AUTHORIZATION

REQUEST FORM

OFFICE UPDATE REQUEST FORM

Fax to Provider Services/Credentialing: (858) 587-1642, or bfriend@ximedinc.com

HOSPITALS

PRIME HEALTHCARE HOSPITALS

TRI-CITY MEDICAL CENTER

FEDERALLY QUALIFIED

HEALTH CENTERS (FQHCs)

LA MAESTRA COMMUNITY HEALTH CENTERS

EMERGENCY/URGENT CARE

Emergency Care Guidelines

URGENT CARE CENTERS

MD TODAY URGENT CARE

URGENT CARE CENTERS

AMERICAN FAMILY CARE (AFC) URGENT CARE

URGENT CARE CENTERS

OCEANSIDE URGENT CARE

SOUTH BAY URGENT CARE

SURGERY CENTERS/

LABORATORY/PHARMACY

SURGERY CENTERS

LABORATORY

PHARMACY

IMAGING/RADIOLOGY CENTERS

IMAGING HEALTHCARE SPECIALISTS (IHS)

VALLEY RADIOLOGY CONSULTANTS MEDICAL GROUP

SKILLED NURSING FACILITIES,

PHYSICAL THERAPY,

HOME HEALTH & DME

SKILLED NURSING FACILITIES/SNF

PHYSICAL THERAPY

HOME HEALTH AGENCIES

DURABLE MEDICAL EQUIPMENT (DME)

DIALYSIS CENTERS

FRESENIUS KIDNEY CARE

AERIAL CARE QUICK START

AERIAL CARE USER GUIDE

AERIAL CARE USER GUIDE

(cont.)

AERIAL CARE USER GUIDE

(cont.)

AERIAL CARE USER GUIDE

(cont.)

AERIAL CARE USER GUIDE

(cont.)

AERIAL CARE USER GUIDE

(cont.)

AERIAL CARE USER GUIDE

(cont.)

AERIAL CARE USER GUIDE

(cont.)

AERIAL CARE USER GUIDE

(cont.)

AERIAL CARE USER GUIDE

(cont.)

AERIAL CARE USER GUIDE

(cont.)

QUALITY MANAGEMENT

DEPARTMENT

Communication

Procedure

Peer Review Activities

QUALITY MANAGEMENT

DEPARTMENT

Peer Review Activities (cont.)

PERFORMANCE PROGRAMS

DEPARTMENT

ANNUAL WELLNESS VISIT (AWV)

GUIDE 2020

ANNUAL WELLNESS VISIT (AWV)

GUIDE 2020

PERFORMANCE PROGRAMS

DEPARTMENT

PERFORMANCE PROGRAMS

DEPARTMENT

PERFORMANCE PROGRAMS

DEPARTMENT

QUALITY MEASURES

QUALITY MEASURES

PERFORMANCE PROGRAMS REWARDS

COZEVA PROGRAM

COZEVA

REVISIONS

Version

Date Revised

quotesdbs_dbs14.pdfusesText_20

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