Information for Providers

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Children's Community Health Plan is committed to providing the best possible service to our members and providers. We welcome you as a provider in our network and thank you for serving our members.

Listed below are the individual sections of the Provider Manual. Download the complete CCHP Provider Manual. (PDF)

Introduction

• Welcome.
• Contact information.
• Integrated voice response (IVR).

Medicaid enrollment process

• Length of enrollment
• Assignment of Primary Care Clinics (PCCs)
• Medicaid identification card
• Temporary and presumptive eligibility cards

Provider responsibilities (PDF)

• Official written notice
• Physician assistance
• Locum Tenens
• Referrals
• Prior authorizations
• Requests to terminate patient/doctor relationships
• Not accepting new patients
• No-show policy
• Arranging substitute coverage
• Member notification of physician departure from network
  - Transition of patient care
• Advance directives
• Medical Records
• Member rights and responsibilities

Prior authorizations

• Planned inpatient hospital admissions
• Emergency care services
• Urgent/non-emergent care
• Prior authorization list

Medicaid coding requirements

• Bilateral modifier
• Multiple surgeries
• Enhanced reimbursements
• Health personnel shortage area

Claim submission

• Completing claims
  - Vendor number
  - Individual practitioner number
• Initial claim submission
• Timely filing guidelines
• Claim submission reports
  - Problem claim
• Request form/claim resubmission
  a. Electronic Claims Transmission (ECT) confirmation report 
  b. Paper claims confirmation report
  c. Rejected claims
• Explanation of payment 
• Claim adjustments

Medicaid provider appeals process

• Claim overpayment refund
• Claim reversal adjustment
• Claim submission
• Denied service
• Paid service
• Problem claim request
• Referral authorization

Health check program

• Description
• Exam components
• Reporting and member outreach
• Billing
• Vaccines for Children program (VFC)
• Forms

ASH Reporting – Abortion, Sterilization and Hysterectomy