| Policy Name |
Policy Number |
Review Date |
|---|
| 3rd Trimester Pregnancy IPA Transfer Policy |
Admin 37 |
11/14/2024 |
| 3rd Trimester Pregnancy IPA Transfer Procedure |
Admin 37A |
12/1/2022 |
| A Woman's Principal Healthcare Policy |
Admin 44 |
10/24/2024 |
| A Woman's Principal Healthcare Procedure |
Admin 44A |
11/1/2022 |
| Ancillary Hospital Institution Care Transition Exceptions Policy |
Admin 11 |
12/19/2024 |
| Ancillary Hospital Institution Care Transition Exceptions Procedure |
Admin 11A |
1/1/2023 |
| Automatic Approval Process Policy |
Admin 53 |
11/14/2024 |
| Automatic Approval Process Procedure |
Admin 53A |
12/1/2022 |
| Complex Case Management Policy |
Admin 71 |
6/1/2022 |
| Complex Case Management Procedure |
Admin 71A |
6/1/2022 |
| Contract Management Firms Confidentiality Agreement Policy |
Admin 14 |
10/24/2024 |
| Contract Management Firms Confidentiality Agreement Procedure |
Admin 14A |
11/1/2022 |
| Corrective Action for Failed Utilization Management Audit of Participating IPAs Policy |
Admin 33 |
11/1/2021 |
| Corrective Action for Failed Utilization Management Audit of Participating IPAs Procedure |
Admin 33A |
11/1/2021 |
| Collaborative Improvement Coaching for HMO Quality Improvement Projects Policy |
QI 27 |
12/19/2024 |
| Collaborative Improvement Coaching for HMO Quality Improvement Projects Procedure |
QI 27A |
1/1/2023 |
| Emergency Room Services Policy |
UM 1 |
5/1/2022 |
| Emergency Room Services Procedure |
UM 1A |
5/1/2022 |
| HMO Administered Complaints Policy |
Admin 39 |
12/19/2024 |
| HMO Administered Complaints Procedure |
Admin 39A |
6/1/2022 |
| HMO Financial Risk Claims Policy |
Admin 67 |
11/14/2024 |
| HMO Financial Risk Claims Procedure |
Admin 67A |
12/1/2022 |
| IPA Availability and Accessibility Requirements for Immediate Care Services Policy |
Admin 83 |
2/1/2023 |
| IPA Availability and Accessibility Requirements for Immediate Care Services Procedure |
Admin 83A |
2/1/2023 |
| IPA Infertility and Fertility Treatment Guidelines |
Admin 56 |
12/19/2024 |
| IPA Guidelines for Member Complaints, Inquiries, Appeals and Grievances Policy |
Admin 22 |
4/1/2023 |
| IPA Guidelines for Member Complaints, Inquiries, Appeals and Grievances Procedure |
Admin 22A |
4/1/2023 |
| IPA Process for Establishing Out of Area for Emergency Services Policy |
Admin 23 |
4/1/2023 |
| IPA Process for Establishing Out of Area for Emergency Services Procedure |
Admin 23A |
4/1/2023 |
| IPAs Request for Member Transfer Policy |
Admin 28 |
3/1/2023 |
| IPAs Request for Member Transfer Procedure |
Admin 28A |
3/1/2023 |
| Member Access to Behavioral Health Services Policy |
Admin 64 |
12/19/2024 |
| Member Access to Behavioral Health Services Procedure |
Admin 64A |
1/1/2023 |
| Member Notification Process when a Provider Leaves the IPA Policy |
Admin 82 |
4/1/2023 |
| Member Notification Process when a Provider Leaves the IPA Procedure |
Admin 82A |
4/1/2023 |
| Newborn Claim Responsibility Policy |
Admin 31 |
4/1/2023 |
| Newborn Claim Responsibility Procedure |
Admin 31A |
4/1/2023 |
| Oversight of Contracted Infertility Vendor Policy |
UM 3 |
6/1/2022 |
| Oversight of Contracted Infertility Vendor Procedure |
UM 3A |
6/1/2022 |
| Past Due Claims Process Policy |
Admin 42 |
10/24/2024 |
| Past Due Claims Process Procedure |
Admin 42A |
11/1/2022 |
| Physician Access Standards Policy |
Admin 10 |
12/1/2022 |
| Physician Access Standards Procedure |
Admin 10A |
11/14/2024 |
| Primary Care Physician (PCP) Affiliation with Multiple IPAs Policy |
Admin 2 |
10/24/2024 |
| Primary Care Physician (PCP) Affiliation with Multiple IPAs Procedure |
Admin 2A |
11/1/2022 |
| Retroactive IPA Member Changes Policy |
Admin 32 |
5/1/2022 |
| Retroactive IPA Member Changes Procedure |
Admin 32A |
5/1/2022 |
| Transition of Medical Care Policy |
Med Support 1 |
4/1/2023 |
| Transition of Medical Care Procedure |
Med Support 1A |
4/1/2023 |
| UM Fund Challenge Policy |
Admin 66 |
7/1/2022 |
| UM Fund Challenge Procedure |
Admin 66A |
7/1/2022 |
| Utilization Management and Case Management Adherence Audit of Participating IPAs Policy |
Admin 60 |
3/1/2022 |
| Utilization Management and Case Management Adherence Audit of Participating IPAs Procedure |
Admin 60A |
3/1/2022 |
