Provider Manual Table of Contents

Please enter any search term below to search the Provider Manual.

SECTION 1: INTRODUCTION, CONTACT AND GENERAL PLAN INFORMATION

SECTION 2: CLAIM SUBMISSION AND REIMBURSEMENT

SECTION 3: UTILIZATION MANAGEMENT INCLUDING AUTHORIZATIONS AND NOTIFICATION REQUIREMENTS

SECTION 4: CARE MANAGEMENT PROGRAM

SECTION 5: BEHAVIORAL HEALTH MANAGEMENT

SECTION 6: (RESERVED FOR FUTURE USE)

SECTION 7: PHARMACY SERVICES

SECTION 8: PROVIDER RESPONSIBILITIES

SECTION 9: QUALITY MANAGEMENT

SECTION 10: APPEALS, INQUIRIES, AND GRIEVANCES

SECTION 11: CREDENTIALING

SECTION 12: MEMBERSHIP OVERVIEW

SECTION 13: BMCHEALTHNET PLAN PRODUCT INFORMATION

SECTION 14: ADDITONAL WAYS WE HELP PROVIDERS

SECTION 15: PROVIDER FORMS