1 OVERVIEW
1.2 Purpose of the Provider Manual
IntegraNet’s Provider Manual is for Physicians, Hospitals and Other Health Care Providers (“Manual”). The Manual is an extension of the participating provider agreement (“Agreement”) between IntegraNet and/or all provider types including, but not limited to, physicians, hospitals and ancillary health care providers (hereinafter collectively and/or individually, as the content requires, referred to as “Provider (s)”).
This Manual furnishes all such participating Providers and their office staff with important information concerning IntegraNet policies and procedures, claims submission and adjudication requirements, and guidelines used to administer IntegraNet’s delegated health plans listed in the Manual. This Manual replaces and supersedes any and all other previous versions and is available on IntegraNetHealth.com. A paper copy may be obtained at any time upon written request to IntegraNet. Any capitalized terms not otherwise defined herein shall have the meaning as set forth in the Agreement.
In accordance with Provider Manual references in the Agreement, Providers are contractually required to abide by all provisions contained in this Manual, as applicable. Revisions to this Manual constitute revisions to IntegraNet’s policies and procedures. Revisions shall become binding ninety (90) days after the date indicated on any notice that is provided by mail or electronic means, or such other period of time as necessary for IntegraNet to comply with any statutory, regulatory and/or accreditation requirements.
As policies and procedures change, updates will be issued in the form of the Physician Quarterly Newsletter, mail, email or fax notification, and may be incorporated into the electronic version and subsequent paper versions of this Manual. Any change in policies and procedures must be implemented according to the time frame included in the Agreement.
Variations in applicable laws, regulations and governmental agency guidance, including, but not limited to state or federal laws, regulations, and/or changes to such laws, regulations or guidance may create certain requirements related to the content in this Manual that are not expressly set forth in this Manual. Any requirements under applicable law, regulation or guidance that are not expressly set forth in the content of this Manual shall be incorporated herein by this reference and shall apply to Providers and/or IntegraNet where applicable. Such laws and regulations, if more stringent, take precedence over the content in this Manual. Providers are responsible for complying with all laws and regulations that are applicable. Note, however, that state law and/or regulations do not affect the adjudication of claims for Medicare Advantage Members.