Provider Manual :: IntegraNet Health

Provider Manual

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This manual provides physicians, hospitals, and other healthcare pracitioners in the IntegraNet network with an easy-to-use guide for services provided by IntegraNet.

FULL MANUAL

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Table of Contents

1 OVERVIEW

1.1 About IntegraNet Health
1.2 Purpose of the Provider Manual

2 MEDICARE ADVANTAGE OVERVIEW

2.1 About Medicare Advantage
2.2 Plans services by IntegraNet Health

3 CONTACT INFORMATION

4 ACCESS TO CARE

5 PROVIDER ROLES AND RESPONSIBILITIES

5.1 The Medicare Advantage Provider Network
5.2 The PCP Role
5.3 The Specialist Role
5.4 Participating Provider Responsibilities

6 PROVIDER NETWORK INFORMATION

7 QUALITY MANAGEMENT

8 HEALTH CARE MANAGEMENT SERVICES

9 HOSPITAL AND ELECTIVE ADMISSION MANAGEMENT

10 MEDICAL RECORDS

11 CREDENTIALING

12 PERFORMANCE AND TERMINATION

12.1 Performance Standards and Compliance
12.2 Physician – Patient Communications
12.3 Plan-specific Termination Criteria
12.4 Notification to Members of Provider Termination

13 COMPLIANCE AND ETHICS (INCLUDING MEDICARE)

14 CLAIM SUBMISSION AND ADJUDICATION PROCEDURES

15 PROVIDER COMPLAINT AND GRIEVANCE PROCEDURE

16 INTEGRANET COMPLAINTS, APPEALS, GRIEVANCES AND DISPUTES

17 MEMBER RIGHTS AND RESPONSIBILITIES

18 MEMBER MANAGEMENT SUPPORT

18.1 Health Promotion
18.2 Member Rewards for Health Program

19 BENEFITS

20 PRESCRIPTION DRUG COVERAGE

21 FORMS

GLOSSARY OF TERMS