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Provider Manual

Provider Manual

Provider Forms

Appeal Reference Form
Provider Data Update Notification Form
Provider Online Access Form
Claim Status Request Form

Medical Management

Prior Authorization Form - Self Funded Plans
Prior Authorization Form - Fully Insured Plans
Medical Management Prior Authorization List

News and Updates

January 31, 2017 - Medicare Outpatient Observation Notice

On December 8, 2016, the Centers for Medicare & Medicaid Services (CMS) released the OMB-approved Medicare Outpatient Observation Notice (MOON). The MOON is mandated by the Federal Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act), passed on August 6, 2015. The MOON is a standardized, written notice explaining that a Medicare beneficiary, including a Medicare Advantage enrollee, is receiving outpatient observation services, and is not an inpatient.

The notice must include the reasons the individual is an outpatient receiving observation services and the implications of receiving such services. Hospitals and critical access hospitals (CAHs) must deliver the notice no later than 36 hours after initiation of observation services. All hospitals and CAHs are required to start providing this statutorily required notification no later than March 8, 2017. Medicare Outpatient Observation Notice and accompanying form instructions are available by clicking here.

September, 2015 - ICD-10 Transition

The transition to ICD-10 will be implemented on October 1, 2015. Please read this letter from CMS regarding the transition. You may also visit CMS.org and the American Medical Association for more information on the transition.

The CMS Blog: One Week Out

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