Information for Providers
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
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