Care Improvement Plus! This provider manual

and data may be submitted to CMS.
Billing of Members
Providers may not bill, charge, collect a deposit from, seek compensation, remuneration, or
reimbursement from or have any recourse against any member for any amount owed by Care
Improvement Plus to Providers. The foregoing does not affect Provider’s obligation to collect
applicable coinsurance, copayments and deductibles as applicable, from members.
Every provider shall indemnify and hold members harmless for any and all debts of provider, amounts
owed to provider by Care Improvement Plus, and any coinsurance, copayments and deductibles owed to
provider by the applicable state Medicaid program.
In order to bill a Care Improvement Plus member for a non-covered service, Providers must inform the
member, and obtain the member’s written acknowledgement that he or she has been informed, in
conformity with the requirements of Section 1879 of the Social Security Act, of the following:
(1) The nature of the non-covered service;
(2) An explanation of why the Provider believes Care Improvement Plus will not cover the service;
and
(3) That the member will be personally and financially liable for payment of the service.
Annual Model of Care Training
As required by CMS, Care Improvement Plus must conduct initial and annual Model of Care training for
our provider network to keep everyone informed about the care management structure and revisions
made based on performance improvement activities. You must satisfy this requirement by completing
the course provided in our learning management system, the University of XLHealth (UXL).
You can access the University of XLHealth at www.xlhealthtraining.com/vendor. Click on the New User
Registration link and complete all required fields. Click the Submit Form button and the Course Catalog
will open displaying all available courses. Select Model of Care 2011 and then the Home tab to launch
the course. Detailed Instructions on how to register can be found in the upper right corner of the home
page, as well as contact information for any questions or issues you may encounter.
SECTION D – PROVIDER RIGHTS AND RESPONSIBILITIES
Primary Care Physician
Care Improvement Plus recognizes the important role that specialists have in the health care needs of our
members. We also recognize the need for a Primary Health Care Provider to coordinate and monitor the
overall clinical care needs of the patient (the physician primarily focuses on clinical aspects related to
their chronic illness). As such, we encourage the member to identify a Primary Care Physician who will
be willing to act in that capacity.
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