Sep 26, 2010 | Medical billing basics
A member or the member’s PCP or specialist may request a second opinion for serious medical conditions or elective surgical procedures. The conditions and/or procedures include, but are not limited to, the following: • Treatment of serious medical conditions, such as...
Sep 18, 2010 | Medical billing basics
Under certain circumstances, a specialist may be approved by Prestige Health Choice to serve as a member’s PCP when a member requires the regular care of the specialist. The criteria for a specialist to serve as a member’s PCP include the existence of a chronic,...
Sep 16, 2010 | Medical billing basics
36. The provider agrees that provisions will be made to minimize sources and transmission of infection. 37. The provider agrees to maintain communication with the appropriate agencies such as local police, social services agencies and poison control centers to provide...
Sep 16, 2010 | Medical billing basics
16. The provider agrees to participate in and cooperate with Prestige Health Choice’s grievance and appeal procedures when Prestige Health Choice notifies the provider of any member complaints or grievances. 17. Balance billing for a covered service is not permitted....
Sep 16, 2010 | Medical billing basics
The network primary care provider (PCP) is responsible for the complete care of his or her members, whether providing directly or by referral to the appropriate provider of care within the network and as such, accepts all associated case management responsibilities....