Table of Contents

1.     Member Information

1.1.       Mercy Health Plan Product Overview

1.2.       Members Rights and Responsibilities

1.3.       Advance Directives

1.4.       Nurse on Call

2.     Provider Relations

2.1.       Provider Relations

2.2.       Freezing Primary Office Enrollment

2.3.       Provider-Initiated Office Change

2.4.       Medical Records

3.     Medical and Pharmacy Benefit Management

3.1.       Provider Responsibilities

3.2.       Out-of-Network Provider Requests

3.3.       Medical Management Services

3.4.       Requests for Documentation of Medical Necessity and Benefit Determinations

3.5.       Utilization Management Adverse Determination Process

3.6.       Mental Health and Substance Abuse Services

3.7.       Pharmacy Benefit Services

4.     Quality Improvement

5.     Credentialing

6.     Clinical Adverse Events Investigations

7.     Fraud, Waste and Abuse

8.     Complaint, Grievance & Appeal Processes

8.1.       Provider Complaint, Grievance, and Appeal Process

8.2.       Member Complaint, Grievance, and Appeal Process

9.     Billing Guidelines

9.1.       Claims Submission

9.2.       Maintaining Accurate Provider Information

9.3.       Billing Guidelines for All Services

9.4.       Billing Guidelines for Professional Services

9.5.       Anesthesia Billing Guidelines: All Plans

9.6.       Surgical Billing Guidelines

9.7.       Obstetrical Billing Guidelines

9.8.       Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)

9.9.       General Institutional Billing Guidelines

9.10.     Correct Coding Software

9.11.     Coordination of Benefits (COB)

10.       Physician and Member Satisfaction Surveys

10.1.     Physician Satisfaction Survey

10.2.     Member Satisfaction Surveys

11.       Benefits and Limitations: Commercial Products

11.1.     Eligibility

11.2.     Benefits

11.3.     Limitations and Exclusions

11.4.     Point of Service (POS) Information

12.       Mercy MedicareADVANTAGE Benefits and Limitations

12.1.     Mercy MedicareADVANTAGE Eligibility Criteria

12.2.     Benefits

12.3.     Transition of Care Form

12.4.     Medicare Reporting Form

12.5      Medicare Risk Adjustment Program

13.       Standards for Medical Record Keeping

13.1.     Confidentiality of Medical Records

13.2.     Medical Record Release to the MHP Member

13.3.     Medical Record Release to Mercy Health Plans

13.4.     Medical Record(s) Maintenance

13.5.     Documentation Standards

13.6.     Medical Record Review/Audit