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COMMUNITY HEALTH PLAN

3.

Assigns PCS code of the supervising physician to a new mid-level provider.

3.

Adds new PCS and/or provider record(s) to the provider network database and PMS.

4.

Updates the provider network database and PMS, as specified in the Change of Information file.

6.

Reassigns members affected by any provider change or deletion identified in the Change of Information file requiring member reassignment and notification.

7.

If Change of Information requires member notification, produces mailing labels for all affected members within seven (7) business days of the request to delete or change a PCP.

8.

Forwards mailing labels to Member Services.

9.

Sends the upload file summary including all adds, deletes, changes to Provider Relations for final approval by 9:00 a.m. no less than one (1) business day prior to the fifteenth (15th) of the month, and with the following pre-conditions: a) The final approved file will not contain any additional new records (adds, deletes, changes); b) Information Systems receives preliminary adds, deletes, changes file in Excel format by 9:00 a.m. three (3) business days prior to the fifteenth (15th) of the month.

1.

Conducts a final edit on the upload file summary prepared by Information Systems by comparing the upload file summary to source documents.

INFORMATION SYSTEMS

PROVIDER RELATIONS

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