- 2023 Provider Reference Guide
- Administrative Info
- Provider Initiatives
- Forms
- Referral Guides
- Educational Resources
- Reference Materials
- Policies and Guidelines
- Administrative Information
Administrative Information
Translated Resources and Materials One-Pager
Remote Access to Medical Records Frequently Asked Questions
ERA Enrollment Instructions
EFT Enrollment Instructions
Authorization Portal Instructions 2021
2023 Provider Benefit Packet
2021 Provider Portal User Guide
Peoples Health Authorization Requirements Link
Peoples Health Authorization Requirements
Search authorization requirements for specific procedure codes
- Provider Forms
Provider Forms
Medical Necessity Form
Home Health Recertification Form
EFT Enrollment Form
Provider Information Change Form (PICF) Link
Provider Information Change Form (PICF)
Use the PICF to update your provider profile and demographic details
Provider Initiatives
Review the attached overview sheets, which provide a short summary of each initiative’s purpose, as well as step-by-step instructions for how you can help make each initiative a success.
- Provider Initiatives
Provider Initiatives
Comprehensive Wellness Assessment (CWA)
Below are additional resources to help encourage your eligible patients to complete the Comprehensive Wellness Assessment (CWA). There is a call script that your staff can use to reach out to patients, a letter that you can send, as well as talking points to help explain the benefits of completing a CWA.
- Comprehensive Wellness Assessment (CWA)
Comprehensive Wellness Assessment (CWA)
- Forms
Forms
Request for Redetermination of Medicare Prescription Drug Denial
Request for Medicare Prescription Drug Coverage Determination Form
Provider Information Change Form
Medicare Outpatient Observation Notice (MOON)
Instructions for the Medicare Outpatient Observation Notice (MOON)
Detailed instructions for how to complete the MOON; CMS requires providers to follow these instructions when completing and distributing the notice.
Access Instructions
Medical Necessity Form
Instructions for the Notice of Medicare Non-Coverage
Instructions for the Detailed Notice of Discharge
Important Message from Medicare (IM)
Instructions for the Important Message (IM) From Medicare
Detailed instructions for how to complete the IM; CMS requires providers to follow these instructions when completing and distributing the notice.
Access Instructions
Home Health Recertification Form
FWA Allegation Referral Form
Compliance Referral Form
- Guides
Guides
Northern Louisiana (S1) Area - Primary Care Physicians
- Advance Care Planning
Advance Care Planning
- Dual Eligible Cost Sharing Information
Dual Eligible Cost Sharing Information
Peoples Health Secure Complete (HMO-POS D-SNP) Cost-Sharing Reference Sheet for Providers and Employees
Model of Care for Special Needs Plans (SNPs)
Details about our model of care for our SNPs
- Health and Chronic Conditions
Health and Chronic Conditions
Identifying and Documenting Heart Failure, Chronic Obstructive Pulmonary Disease and Chronic Kidney Disease
Evidence-Based Practice Guidelines Quick Reference- Prediabetes Diabetes Heart Failure CKD Alzheimer’s Disease and Dementia and COPD
Blood Pressure Documentation and Hypertension Treatment Quick Guide
- HEDIS and Stars
HEDIS and Stars
Medications
Medication Adherence Discussion Guide - High Cholesterol
Medication Adherence Discussion Guide - High Blood Pressure
- Online Authorizations
Online Authorizations
Authorization Portal Instructions
Use these tip sheets to ensure your authorization request is accurately entered, reducing processing time.
- Tip Sheets
Tip Sheets
- Risk Adjustment
Risk Adjustment
- Social Determinants of Health
Social Determinants of Health
2023 Provider Reference Materials
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2023 Formulary Quick Guide 2023 In-Network Physician Office Visit Cost-Sharing 2023 Provider Benefit Packet 2023 Urgent Care Cost Sheet
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2023 Provider Quick Reference Guides Physicians Ancillary Facilities Hospitals Other References Covered Codes for Labs Performed and Processed in Physician Offices Skilled Nursing Facility (SNF) Guide for Hospitals |
2022 Provider Reference Materials
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2022 In-Network Physician Office Visit Cost-Sharing 2022 Provider Benefit Packet
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2022 Provider Quick Reference Guides Physicians Ancillary Facilities Hospitals |
- Evidence Based Practice Guidelines
Evidence Based Practice Guidelines
- Medical Policies
Medical Policies
Indications for Wound Care in Specialized Wound Care Centers
Replacement of Pulse Generators (Battery) and Electrode Leads in Cardiac Pacemakers and Automatic Internal Cardiac Defibrillators
Skilled and Long Term Care Facility Physician Care
Computer-Assisted Surgical Navigation for Musculoskeletal Procedures
Indications for Insertion Removal of Peripherally Inserted Tunneled and Non-Tunneled Central Venous Catheters
Erythropoiesis-Stimulating Agents (ESAS) in Cancer and Related Neoplastic Conditions
Implantable, Wireless, Pulmonary Artery Pressure Monitoring
- Coverage Guidelines