For Providers
At Network, we are committed to building and sustaining long-term relationships with the providers who serve our mutual communities. This is more than a promise. It is a commitment to the level of service, coverage and care that you, as a professional under oath, make to every patient, every day. That same level of service is also what you can expect from us, when our members are in your care.
To help serve you better, we have included information online and at your fingertips, which you will find valuable in continuing or beginning a successful partnership with Network Health Plan.
View the full version of the Network Platinum Medicare Advantage Provider Manual. We have included helpful tools to assist you in locating content within the PDF. When the PDF opens, click on the "Bookmarks" tab – it is the top tab at the left of the panel that displays the PDF content. Then find and click on your topic of interest within the "Bookmarks" panel and the link will take you to the specific pertinent page(s) within the PDF. Alternatively, you can use the "Search" functionality. Just click on the binocular icon in the horizontal toolbar located above the panel that displays the PDF content. That will open a new window that will allow you to enter a search term – then enter your term or phrase and click the "search" button. Your results will appear in a new window below the "search" button.
If you already know what section of information you are looking for you can search and click on any of the links provided below.
I. General Information
C. Disclosure of Quality and Performance Indicators to CMS 129
D. Consideration of Linguistic and Cultural Needs of Members
E. Privacy and Confidentiality of Member Information and Records
F. Business Information Protection
H. Prohibition of Health Screening Prior to Enrollment
I. NHP/NHIC - Access - Practitioner Plan Standards
J. Medical Records Review Process
K. Medicare Required Disclosure of Information to Beneficiaries
L. Termination of Provider Services
M. Grievance Resolution Policy and Procedure for Medicare Advantage Plans
N. Network Health Plan/Network Health Insurance Corporation's Grievance Process
O. Medicare Advantage Plans Financial Affairs and Beneficiary Protection
II. Credentialing
A. Credentialing and Re-Credentialing Processes
III. Care Management
A. Services Requiring Authorization for Medicare Advantage PPO
B. NHIC Medicare Advantage Specialty Care Access
C. Clinical Criteria for Utilization Decisions Provider Authorization Request Process
E. Policy on Incentives for Utilization Decisions
F. CM Staff Accessibility to Members and Practitioners
H. Notice of Discharge and Medicare of Provider Services
I. Termination of Provider Services
J. Notice of Medicare Non-Coverage Forms
K. Network Health Plan Outpatient Treatment Report for Behavioral Form
L. Network Health Plan Outpatient Treatment Report for AODA services- Initial Form
M. Network Health Plan Outpatient Treatment Report for AODA services - Concurrent Form
IV. Claims
A. CMS - 1500 Professional Claim Information
B. UB-04 Uniform Billing Claim Implementation
D. Medicare Provider Payment Dispute and Appeal Rights Process