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11/2005
Table of Contents
Introduction.............................................................................................1
Description of Products ..................................................................... 2 - 3
Responsibilities of Hospital................................................................ 4 - 5
Quick Reference Guide....................................................................... 6 - 8
Provider Access .............................................................................. 9 - 10
Eligibility & Benefits Verification .................................................... 11 - 13
Utilization Management................................................................. 14 - 26
Non-Compliance Policy .........................................................................27
Quality Improvement ..................................................................... 28 - 34
Continuity and Coordination of Care......................................................35
Laboratory Services................................................................................36
Claim Submission .......................................................................... 37 - 43
Collecting Payment from Members ........................................................44
Claim Processing ...................................................................................45
In the event of a conflict between this Physician Office Manual and the Physician Agreement
or the Physician Office Manual and the Membership Agreement the Physician Agreement or
the Membership Agreement respectively will control.