2013 Practitioner and Provider Manual - Presbyterian Healthcare ...

Presbyterian Healthcare Services(HSD’s) Category of Eligibility 100. Eligibility isbased on income, rather than the multiple eligibilitycategories that were used before. To be eligible forABP, enrollees must be adults between the ages of19 and 64 who are at or below 138% of the FederalPoverty Level (FPL).Qualifying adults will receive ABP services throughPresbyterian Centennial Care. Native Americanswho are eligible through the expansion may enrollin Centennial Care or receive services through feefor service.ABP members will be assessed co-paymentsbased on income level for outpatient and inpatientservices and may be subject to additional copaymentsfor unnecessary services.Covered Services and Authorization:Refer to the Alternative Benefits Package Detailstable for a list of services included under theCentennial Care Alternative Benefit Package.Please note the covered services and authorizationrequirements may differ from regular CentennialCare.Please refer to Appendix G for a list of ABPcoveredservices.Regulatory Agency WebsitesThis Presbyterian 2014 Provider Manualincorporates information from regulatory agenciesabout requirements for Presbyterian’s product lines.For more information about regulatoryrequirements, please visit the websites listed in theRegulatory Agencies Website table.1-32014 Practitioner and Provider Manual - Ver. 3