Reference Materials

• 2022 Provider and Billing Manual (PDF)
  
• 2021 Provider and Billing Manual (PDF)
  
• 2020 Provider & Billing Manual (PDF)
• Quick Reference Guide (PDF)
• ICD-10 Information
• Payspan (PDF)
• Secure Portal (PDF)
• 2022 Network Overview (PDF)
• 2022 Provider Orientation (PDF)
  

Quality Improvement/Risk Adjustment

• HEDIS® MY 2021 (PDF)
• 2021 QUALITY RATING SYSTEM (QRS) AT-A-GLANCE (PDF)
  

Medical Management/ Behavioral Health

• Prior Authorization Guide
• Inpatient Prior Authorization Fax Form (PDF)
• Outpatient Prior Authorization Fax Form (PDF)
• Biopharmacy Outpatient Prior Authorization Fax Form (PDF)
• Prior Authorization Request Form for Non-Specialty Drugs (PDF)

Claims and Claims Payment

• Claim Dispute Form (PDF)
• No Surprises Act Open Negotiation Form (PDF)
  

Quality

• Practice Guidelines (PDF)