Provider Manual

The Community Health Plan Provider Manual provides an overview of Community Health Plan. It links to forms, procedures, and references to help you provide better service. 

Download the 2010 Provider Manual.

For tools and information, see:


The 2010 edition of the Provider Manual incorporates updates and new content, such as:

  • Directory of services and contacts UPDATES
    • Provider Relations
    • Access to care standards
    • Credentialing UPDATES
    • Access to enrollee health information
    • Medical record documentation standards and policies NEW
  • Eligibility
    • Disenrollment
  • ID cards UPDATES
  • Enrollee benefits UPDATES
  • Children First™
  • Enrollee rights & responsibilities NEW
  • Notice of Privacy Practices NEW
  • Advance directives NEW
  • Billing and claims payment
    • Where to send claims NEW
  • Appeals
  • Care management and utilization management UPDATES
    • Referrals
    • Prior authorization
    • Pre-existing conditions (Basic Health)
  • Case management
    • Referrals
    • Member Review and Intervention Program (MRIP)
  • Disease management
  • Pharmacy management
    • Formulary
    • Prior authorization
    • Benefit exclusions
  • Quality program UPDATES

 
If you have questions regarding any policies and procedures explained in the manual, please contact your Provider Relations Coordinator: Phone 1-800-440-1561 or fax 206-613-5018.