Provider Guide - the Culinary Health Fund

October 2012
Provider Guide
Contract Information
All Primary Care Physicians (PCPs) and specialty physician groups are contracted directly with Culinary
Health Fund Administrative Services, LLC. Please contact Provider Services at 702-892-7313, option 1 with
any questions regarding a physician/group provider contract. Forms in the back of this book have been
provided to assist in requesting a new contract, updating your practice information or requesting contract
allowables. You may also find printable forms on our website at www.culinaryhealthfund.org.
Ancillary providers are those providers of services such as skilled nursing, home health, durable medical
equipment, outpatient rehabilitation, as well as facility-based services such as ambulatory surgery, dialysis,
laboratory and diagnostic testing. Please contact Provider Services at 702-892-7313, option 3, with any
questions regarding your ancillary contract.
Remember the following requirements per your agreement with the Culinary Health Fund:
• Referrals: Participants and their eligible dependents must be referred to Culinary PPO providers.
The referring physician will be financially responsible for referrals to non-PPO providers when a PPO
Provider is available.
• Co-pays/Coinsurance/Deductibles: Culinary participants are responsible only for applicable co-pays,
coinsurance, and/or deductibles for covered services. All other charges for covered services are not the
responsibility of the participant, and the participant cannot be balanced-billed.
• Prior Authorization: The provider is responsible for obtaining prior authorization from American Health
Holding, Inc. (AHH), for all services that require prior authorization, including, but not limited to:
1) Non-emergency inpatient services.
2) Outpatient covered services.
3) All referrals to non-PPO providers.
4) Outpatient chemo/radiation therapy.
• HealthHelp: Effective August 1, 2012, the following requests will now be authorized by HealthHelp:
• Diagnostic Imaging: CT, CTA, MRI, MRA, PET and cardiac nuclear medicine scans.
• Medical Oncology treatments: Chemotherapy, hormone therapy, biologics, supportive care
medications related to a cancer diagnosis.
• Radiation Oncology treatments: two-dimensional (2D) and three-dimensional (3D) conformal
radiation, intensity-modulated radiation therapy (IMRT), brachytherapy, stereotactic radiation therapy
and proton-beam procedures.
• Out of Area: Before referring a patient out of the area for any specialized services, please contact
American Health Holding, Inc. (AHH) at 866-330-2307. New technologies and services are evolving
all the time and we at the Culinary Health Fund want to assist you with the proper access for these
services.
Culinary Health Fund Administrative Services, LLC
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