We recognize that, at times, the administrative requirements of managing your patients' health care can be complex. The Provider Manual is a source of answers to questions you may have about health plan coverage procedures, policies and other facts related to your provision of health care services to our members.

 

Preface
 

Table of Contents

 

Section 1 - All About 'Ohana

 

Section 2 - Provider Responsibilities

 

Section 3 - Member Services

 

Section 4 - Utilization Management

 

Section 5 - Pharmacy Overview

 

Section 6 - Claims

 

Section 7 - Appeals and Grievances

 

Section 8 - Credentialing

 

Section 9 - Quality Improvement

 

Section 10 - Medical Records

 

Section 11 - Case Management

 

Section 12 - Behavioral Health

 

Section 13 - Cultural Competency

 

Section 14 - Provider Education Materials

 

Section 15 - Forms

Section 16 - Quick Reference Guide