Care Improvement Plus! This provider manual

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APPENDIX C – Utilization Management Authorization Rules 43
APPENDIX C – Utilization Management Authorization Rules 44
Page 1 and 2: 2012 Care Improvement Plus Provider
Page 3 and 4: Pharmacy Appeals…….............
Page 5 and 6: SECTION A - INTRODUCTION Welcome We
Page 7 and 8: qualify for programs that they may
Page 9 and 10: • Providers must render service a
Page 11 and 12: and data may be submitted to CMS. B
Page 13 and 14: • Obtain authorizations as approp
Page 15 and 16: mailing may highlight the providers
Page 17 and 18: Little Rock, AR 72203 http://www.ar
Page 19 and 20: Care Improvement Plus maintains a c
Page 21 and 22: (Clinical and/or coverage determina
Page 23 and 24: initial ninety (90) day period. SEC
Page 25 and 26: The Chief Medical Officer (CMO) and
Page 27 and 28: line, or going online at www.careim
Page 29 and 30: Other HIPAA Administrative Simplifi
Page 31 and 32: named transactions. Code sets are i
Page 33 and 34: As outlined in the Federal Regulati
Page 35 and 36: APPENDIX A - Sample Care Improvemen
Page 37 and 38: APPENDIX C - Utilization Management
Page 43: APPENDIX C - Utilization Management
Page 55 and 56: APPENDIX D - Part B Drug Authorizat
Page 57 and 58: Notice of Privacy Practices Effecti
Page 59 and 60: ■ Other uses and disclosures of y
Page 61 and 62: an insurance policy or claim or for
Page 63 and 64: APPENDIX G - Filing Claims with CIP
Page 69 and 70: APPENDIX H - Filing Claims with CIP
Page 71: Address 351 W. Camden Street, Suite

Care Improvement Plus! This provider manual

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