INTRODUCTION
Introduction
Appendix (Physician’s News)
PHYSICIAN RESPONSIBILITIES
Physician Responsibilities
Appendix
- After Hours Care-QM Recommendations
- Sample After Hours phone Message
- Access Standards
- Reference Numbers – Interpretive and Language Services
- Request/ Refusal Forms
- ICE Provider Toolkit
ENROLLMENT AND ELIGIBILITY
Enrollment and Eligibilty
Appendix
- Viewing Eligibilty Inquiry
- Santa Clara County Community Resources
- Subscriber/ Member Information Request Form
- Eligibilty Waiver Form (Letter of Guarantee)
- Introduction to Comprehensive Perinatal Services Program (CPSP)
CLAIMS
Claims
Appendix
- Claims Inquiry
- Possible Third Party Liability Form
- Third Party Lien Assignment Form
- Claims Settlement Practices & Dispute Resolution
AUTHORIZATION PROCESS
Authorization Process
Appendix
- Authorization Process Overview
- Authorization Request Form
- Authorization/Referral Inquiry
- Adding a Referral Request
- Anthem Prescription Drug Prior Auth Request Form
UTILIZATION MANAGEMENT
QUALITY MANAGEMENT
Quality Management
Appendix
- Advance Health Care Directive
- Advance Directives
- Code of Regulations
- If You Have a Concern
- Member Concern Form
- Sample – Provider Office Policy
- Sample – Confidentiality Agreement for Provider Staff
- Ambulatory Medical Record Review Tool
GUIDELINES
Guidelines
Appendix
- Recommended Childhood & Adolescent Immunization Schedule (English)
- Recommended Childhood & Adolescent Immunization Schedule (Spanish)
- Guidlines for Diagnosis & Management of Asthma
- Basic Guidelines For Diabetes Care
- Congestive Heart Failure Practice Guidelines
- Health Education Materials Order Form
- Preventive Health Guidelines for Children
- Preventive Health Guidelines for Adult