Provider manuals and guidelines
We’re committed to supporting you in providing quality care and services to the members in our network. Here you will find information for assessing coverage options, guidelines for clinical utilization management, practice policies and support for delivering benefits to our members.
Provider Manual
Our Provider Manual provides key administrative information, including the quality improvement program, the utilization management program, quality standards for participation, claims appeals, and reimbursement and administration policies.
View or download the Provider Manual.
Medical Policies and Clinical Utilization Management (UM) Guidelines
Medical policy addresses the medical necessity of new services or procedures and new applications of existing services or procedures. Clinical UM Guidelines focus on detailed selection criteria, goals, lengths of stay and locations for generally accepted technologies or services.
- Clinical Practice Guidelines
- Medical Policies update
- Medical Policies and Clinical Utilization Management Guidelines update
- Mar 2019 Medical Policies and Clinical Utilization Management Guidelines update
- June 2019 Medical Policies and Clinical Utilization Management Guidelines update
- August 2019 Clinical Utilization Management (UM) Guidelines Update
- November 2019 Clinical Utilization Management Guidelines
- February 2020 Clinical Utilization Management Guidelines
- May 2020 Clinical Utilization Management (UM) Guidelines