Provider Manual

Table of Contents 

• Mission Statement
• Preface
• Confidentiality Statement
• Members Rights and Responsibilities
• Member Eligibility Verification Procedures
• Primary Care Physician Program
• Physician's Office DME/Supplies Policy
• Physician Referral Procedures
• Directory to Plan Providers
• Preauthorization/Authorization of Services
• Hospitalization Procedures
• Utilization Management Plan
  • Technology Assessment Program
• Physician Reports
• Quality Improvement Program
  • Clinical Guidelines
  • RQI Program Description
  • RQI Provider Portal
  • RQI Clinical Guidelines 
  • RQI CPT Codes
  • RQI CPT Code Updates for 2008
• Laboratory
• Pharmacy Services
• SeniorCare Program
• Claims and Billing Information
• Affiliation Agreement and Credentialing
• Physician Appeals Policy
  • Provider Appeal Form
  • Quick Reference Guide
• Physician Advertising
• Provider Additions and Terminations
• Provider Newsletters
• Physician Office Visit Information Form

SWHP110

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