Participating Provider Guide
The Participating Provider Guide (Dev 08/05) is part of your agreement with the Health Plan and is effective November 1, 2005 for all participating providers. It is designed for use by participating providers and their office staff who provide and coordinate services to Health Plan members. The Participating Provider Guide (Dev 08/05) includes detailed reference information about the Health Plan, referrals and coordination of services, claim reporting requirements, quality improvement, utilization management, member rights and responsibilities, plus much more.
Please contact your Provider Relations Representative if you have any questions concerning the information contained within your Provider Guide.
Provider Letter and Table of Contents
Section 1: General Information
Section 2: Referrals
Section 3: Precertification Requirements
Section 4: Reimbursement and Claim Submission
Section 5: Credentialing
Section 6: Provider Administrative Rights
Section 7: Member Rights and Responsibilities
Section 8: Additional Participating Provider Responsibilities
Section 9: Medical Management and Quality Improvement/Accreditation
Section 10: Health Plan Reports and Forms
Section 11: Glossary and Acronyms
Operations Bulletins that amend this Provider Guide
Provider Network Management Offices
Danville |
(800) 876-5357 |
Harrisburg |
(888) 281-5338 |
Sayre |
(800) 734-3141 |
Scranton |
(800) 350-6486 |
State College |
(888) 669-4834 |