Transcription of Professional Provider Manual - provider.carefirst.com
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Professional Provider Manual - provider.carefirst.com
1 2 Table of Contents Chapter 1: Welcome to carefirst .. 6 Introduction to carefirst .. 7 Online Resources and Contact Information .. 7 Introduction to the Manual How to Use this Manual .. 7 New Providers/Office Staff Begin 8 Chapter 2: Product Descriptions Overview .. 10 BlueChoice Products .. 10 Preferred Provider Organization .. 11 Exclusive Provider Organization .. 11 HealthyBlue .. 11 Federal Employees Health Benefit Plan/Federal Employee Program .. 11 BlueCard 21 Network Lease/Third Party Administrators .. 40 Chapter 3: Provider Network Requirements .. 45 Credentialing .. 46 Practice Transformation .. 52 Provider Score .. 56 Role of the PCP BlueChoice Only .. 56 Reduction, Suspension or Termination of 57 Quality of Care Termination .. 58 All Other Sanctions or Terminations .. 58 Member to be Held Harmless .. 58 Reimbursement .. 59 Reimbursement for Limited Licensed 62 Physician Assistants, Anesthesia Assistants, Assistant Behavior Analysts and Registered Behavior Technicians.
Table of Contents PM0006‑1E (7/19) OB/GYN services quick reference guide Oral surgery Orthopedics Physical, occupational and speech therapy Podiatry
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