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SelectHealth Provider Reference Manual

Navigating the complicated world of health insurance can be an overwhelming task. We value our partnership with you and want to help make the process as simple and easy as possible. We hope the SelectHealth Provider Reference Manual will help make this possible.

 
Table of Content 

 

  • Introduction
     - Benefits and Responsibilities of Participation
  
  • Access and Availablity
​​
  • Auto Recovery 

  • Care Management

  • Care Process Models (CPM) 

  • Claims Filing Deadline

  • Claims-Submission: Electronic Data Interchange (EDI)  

  • Coordination of Benefits (COB) 

    • Credentialing Policy and Procedure   
         - Participating Provider Agreement  
         - Initial Credentialing Appointment
         - Recredentialing/Reappointment
         - 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 Facility
         - Credentialing Non-Accredited Behavioral Health Facility
         - Credentialing Denial, Termination and Appeal/Grievance

        • Evaluation of Emerging Healthcare Technologies

        • Fraud & Abuse

        • Glossary and Acronyms 

        • Healthy Beginnings 

        • Member Advocates 

        • Member Appeals and Grievances - Commercial Plans

        • Member Appeals and Grievances - Government Plans

        • Medical Necessity and Prior Authorization 

        • Member Rights and Responsibilities - Commercial Plans

        • Member Rights and Responsibility - CHIP

        • Pharmacy Tools
             - Formulary Search
             - P & T Newsletter
             - Retail 90 and Pharmacy Search

        • Product Overview - ID Card Guide

        • Pre-Existing Conditions (PEC) 

        • Preventive Care Recommendations 

        • Preauthorization

        • Preauthorization Guidelines

        • Provider Appeals

        • Provider Remittance Advice 

        • Provider Responsibilities

        • Public Reporting

        • Quality Improvement

        • Subrogation

        • Utilization Management Incentives Policy 

        • Who To Contact
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