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SelectHealth CHIP Provider Reference Manual

Navigating the complicated world of health insurance and CHIP can be an overwhelming task. We hope the SelectHealth Advantage Provider Reference Manual will make it a little simpler.

Table of Content

  • Introduction
    • - Benefits and Responsibilities of Participation
  • Auto Recovery
  • Care Management
  • Care Process Models (CPM)
  • Claims Filing Deadlines
  • Claims Submission: Electronic Data Interchange (EDI)
  • Contact Information
  • Coordination of Benefits (COB)
  • Credentialing Policy and Procedure
    • - Credentialing Process
    • - Initial Credentialing Appointment
    • - Credentialing of Ancillary Practitioners
    • - Ancillary Provider Recredentialing/Reappointment
    • - Credentialing Accredited Hospitals
    • - Credentialing for Non-Accredited Hospitals
    • - Credentialing for Free-Standing Surgical Centers
    • - Credentialing for Skilled Nursing Facilities
    • - Credentialing for Home Health Agencies
    • - Credentialing Accredited Behavioral Health Facilities
    • - Credentialing Non-Accredited Behavioral Health Facilities
    • - Credentialing Denial, Termination and Appeal/Grievances
  • Evaluation of Emerging Healthcare Technologies (MTECH)
  • Fraud & Abuse
  • Glossary & Acronyms
  • Medical Necessity & Prior Authorization
  • Member Advocates
  • Member Appeals and Grievances - Government Plans
  • Member Rights and Responsibilities - Commercial Plans
  • Participating Provider Agreement
  • Pharmacy Tools
    • - Formulary Search
    • - P&T Newsletter
    • - Retail 90 and Pharmacy Search
  • Pre-Existing Conditions (PEC)
  • Preventive Care Recommendations
  • Prior Authorization
  • Prior Authorization Guidelines
  • Provider Appeals
  • Product Overview - ID Card Guide
  • Provider Remittance Advice
  • Provider Responsibilities
  • Public Reporting
  • Quality Improvement
  • Subrogation
  • Utilization Management Incentives Policy

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