1.1. Mercy Health Plan Product Overview
1.2. Members Rights and Responsibilities
2.2. Freezing Primary Office Enrollment
2.3. Provider-Initiated Office Change
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
6. Clinical Adverse Events Investigations
8. Complaint, Grievance & Appeal Processes
8.1. Provider Complaint, Grievance, and Appeal Process
8.2. Member Complaint, Grievance, and Appeal Process
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
9.11. 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
11.3. Limitations and Exclusions
11.4. Point of Service (POS) Information
12. Mercy MedicareADVANTAGE Benefits and Limitations
12.1. Mercy MedicareADVANTAGE Eligibility Criteria
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