Administrative Information

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Translated Resources and Materials One-Pager

Find resources to assist in offering culturally and linguistically appropriate services.
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Date added: 06/14/2021
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Remote Access to Medical Records Frequently Asked Questions

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Date added: 02/21/2023
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ERA Enrollment Instructions

Learn how to sign up with Change Healthcare to receive electronic claims remittance advice.
Size: 471.43 KB
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Date added: 05/17/2021
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EFT Enrollment Instructions

EFT is a free and secure way for providers to receive faster claims payments, and it eliminates long wait times for payment checks to arrive via mail.
Size: 37.22 KB
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Date added: 05/17/2021
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Authorization Portal Instructions 2021

Step-by-step instructions for entering authorization requests.
Size: 1.55 MB
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Date added: 06/30/2021
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2023 Provider Benefit Packet

This packet is a supplement to the Provider Reference Guide and includes a comprehensive list of in-network benefits for each plan.
Size: 508.70 KB
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Date added: 05/17/2021
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2021 Provider Portal User Guide

Learn how to navigate provider portal, add new users, submit authorizations, claims inquiries and more.
Size: 3.29 MB
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Date added: 11/01/2021

Peoples Health Authorization Requirements Link

Peoples Health Authorization Requirements
Search authorization requirements for specific procedure codes

Provider Forms

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Medical Necessity Form

Use to submit an authorization request for services requiring screening against medical necessity guidelines
Size: 282.16 KB
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Date added: 08/26/2021
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Home Health Recertification Form

Send updates on home health services provided to our plan members, as well as to request recertification for services to be continued
Size: 1.24 MB
Hits: 80
Date added: 04/05/2021
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EFT Enrollment Form

EFT is a free and secure way for providers to receive faster claims payments, and it eliminates long wait times for payment checks to arrive via mail.
Size: 200.34 KB
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Date added: 05/17/2021

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

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Seven Day Post Discharge Follow-up

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Date added: 05/17/2021
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Comprehensive Wellness Assessments

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Date added: 05/17/2021
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Closing Gaps in Care

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Date added: 05/17/2021
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Chronic Condition Assessment Rule Out

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Date added: 01/13/2022

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)

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CWA Call Script

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Date modified: 01/13/2022
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Provider Talking Points

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Date modified: 04/28/2022
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Provider Letter

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Date modified: 01/13/2022
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Provider Handout

Size: 1.45 MB
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Date modified: 08/17/2022

Forms

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Provider Information Change Form

Used to update provider office demographic information
Size: 450.43 KB
Hits: 273
Date added: 05/17/2021
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Notice of Medicare Non-Coverage (NOMNC)

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Date added: 05/17/2021
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Medicare Outpatient Observation Notice (MOON)

The MOON informs patients that they are outpatients receiving observation services and not hospital inpatients.

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
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Date added: 05/17/2021
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Medical Necessity Form

For procedures requiring prior authorization.
Size: 282.16 KB
Hits: 3597
Date added: 08/26/2021
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Instructions for the Notice of Medicare Non-Coverage

Detailed instructions for how to use, deliver and complete the NOMNC; CMS requires providers to follow these instructions when completing and distributing the NOMNC
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Date added: 05/17/2021
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Instructions for the Detailed Notice of Discharge

Detailed instructions for how to complete the DNOD; CMS requires providers to follow these instructions when completing the DNOD
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Date added: 05/17/2021
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Important Message from Medicare (IM)

The IM tells hospital inpatients about their discharge appeal rights. Hospitals must give the IM to all inpatients.

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
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Date added: 03/22/2023
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Home Health Recertification Form

Used to provide updates on home health services provided to our plan members, as well as to request recertification for services to be continued.
Size: 248.05 KB
Hits: 890
Date added: 05/17/2021
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FWA Allegation Referral Form

Used to report suspected incidences of fraud, waste or abuse
Size: 125.00 KB
Hits: 61
Date added: 05/17/2021
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Detailed Notice of Discharge (DNOD)

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Date added: 05/17/2021
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Compliance Referral Form

A standard form for reporting suspected compliance violations
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Date added: 05/17/2021

Guides

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Southland Area - Specialists

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Date added: 01/04/2022
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Southland Area - Primary Care Physicians

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Date added: 01/04/2022
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Northlake Area - Specialists

Size: 193.62 KB
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Date added: 01/04/2022
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Northlake Area - Primary Care Physicians

Size: 38.96 KB
Hits: 75
Date added: 01/04/2022
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Northern Louisiana (S1) Area - Specialists

Size: 345.68 KB
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Date added: 01/04/2022
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Northern Louisiana (S1) Area - Primary Care Physicians

Size: 263.47 KB
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Date added: 01/04/2022
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New Orleans Area - Specialists

Size: 357.11 KB
Hits: 128
Date added: 01/04/2022
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New Orleans Area - Primary Care Physicians

Size: 73.24 KB
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Date added: 01/04/2022
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Capital Area - Specialists

Size: 227.81 KB
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Date added: 01/04/2022
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Capital Area - Primary Care Physicians

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Date added: 01/04/2022

Advance Care Planning

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Serious Illness Conversation Guide

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Date added: 05/17/2021
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SPIKES

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Date added: 05/17/2021
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Louisiana Advance Directives Booklet

Size: 249.30 KB
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Date added: 05/17/2021
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LaPOST

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Date added: 05/17/2021
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Advance Care Planning Fact Sheet

Size: 1.29 MB
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Date added: 05/17/2021
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Additional Resources

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Date added: 05/17/2021

Dual Eligible Cost Sharing Information

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Peoples Health Secure Complete (HMO-POS D-SNP) Cost-Sharing Reference Sheet for Providers and Employees

Resource that explains patient cost-sharing for Peoples Health Secure Complete patients with partial Medicaid. As a reminder, you may not collect cost-sharing from Peoples Health Secure Complete patients with full Medicaid coverage or a status of FBDE, QMB, QMB+ or SLMB+.
Size: 172.81 KB
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Date added: 05/17/2021

Model of Care for Special Needs Plans (SNPs)
Details about our model of care for our SNPs

HEDIS and Stars

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Provider Handout - Care Coordination

Size: 149.97 KB
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Date added: 06/20/2023
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HEDIS Measures Coding Cheat Sheet

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Date added: 05/17/2021
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Chronic Care Management Checklist

Size: 636.21 KB
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Date added: 06/13/2023
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Accessing PCP Star Reports in Member Viewer

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Date added: 05/17/2021

Medications

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Opioid-Benzodiazepine Patient Fact Sheet

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Date added: 05/17/2021
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Medication Adherence Discussion Guide - High Cholesterol

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Date added: 05/17/2021
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Medication Adherence Discussion Guide - High Blood Pressure

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Date added: 05/17/2021
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Medication Adherence Discussion Guide - Diabetes

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Date added: 05/17/2021
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Medication Adherence - Provider Handout

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Date added: 01/05/2023

Online Authorizations

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Authorization Portal Instructions

Step-by-step instructions for entering authorization requests.
Size: 1.55 MB
Hits: 129
Date added: 06/30/2021
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2023 Provider Portal User Guide

Size: 3.05 MB
Hits: 215
Date added: 11/01/2021

Use these tip sheets to ensure your authorization request is accurately entered, reducing processing time.

Tip Sheets

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Outpatient Procedures and Testing

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Date added: 05/18/2021
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Inpatient vs. Observation Admissions

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Date added: 05/18/2021
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Infusions Injection and Radiation

Size: 620.94 KB
Hits: 72
Date added: 03/10/2022
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Infusions Injection and Oncology

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Hits: 67
Date added: 05/17/2021
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Home Health and Outpatient Therapies

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Date added: 05/17/2021
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DME and Diabetic Supplies

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Date added: 05/24/2021

Risk Adjustment

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Risk Adjustment Best Practices

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Date added: 05/18/2021
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Diseases and Conditions Associated With HCCs

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Date added: 05/18/2021

Social Determinants of Health

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Addressing Social Determinants of Health

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Date added: 05/17/2021

2023 Provider Reference Materials

2023 Formulary Quick Guide
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2023 In-Network Physician Office Visit Cost-Sharing
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2023 Provider Benefit Packet
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2023 Urgent Care Cost Sheet
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2023 Provider Quick Reference Guides

Physicians
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Ancillary Facilities
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Hospitals
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Other References

Covered Codes for Labs Performed and Processed in Physician Offices
Effective for dates of service starting 2/1/2023
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Skilled Nursing Facility (SNF) Guide for Hospitals
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2022 Provider Reference Materials

2022 In-Network Physician Office Visit Cost-Sharing
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2022 Provider Benefit Packet
PDF icon Download PDF

 

 

 

2022 Provider Quick Reference Guides

Physicians
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Ancillary Facilities
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Hospitals
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Evidence Based Practice Guidelines

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Evidence-Based Practice Guidelines - 2022

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Date added: 03/15/2022

Medical Policies

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Indications for Wound Care in Specialized Wound Care Centers

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Date modified: 01/13/2022
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Gene Expression Profiling

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Date modified: 03/15/2022
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Skilled and Long Term Care Facility Physician Care

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Date modified: 03/15/2022
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Medical Necessity for Private Room

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Date modified: 01/13/2022
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Cologuard MP

Size: 29.18 KB
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Date modified: 01/13/2022
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Daily Inpatient Physician Rounds

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Date modified: 01/13/2022
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Chemotherapy Associated Drugs Treatment

Size: 121.25 KB
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Date modified: 03/15/2022
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Coverage for Walkers and Canes

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Date modified: 03/15/2022
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Denosumab (Prolia and Xgeva)

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Date modified: 03/15/2022
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DME Non-Covered Items

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Date modified: 03/15/2022
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Gonadotropin Releasing Hormone Analogs

Size: 95.02 KB
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Date modified: 03/15/2022
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Implantable, Wireless, Pulmonary Artery Pressure Monitoring

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Date modified: 03/15/2022
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Medications Drugs Outpatient Part B

Size: 206.22 KB
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Date modified: 03/15/2022
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Prostatic Urethral Lift

Size: 34.79 KB
Hits: 33
Date modified: 03/15/2022
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Somatostatin Analogs

Size: 90.21 KB
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Date modified: 03/15/2022
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White Blood Cell Colony Stimulating Factors

Size: 95.80 KB
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Date modified: 03/15/2022

Coverage Guidelines

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Coverage Guidelines_01.12.22

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Date added: 01/13/2022