Reference Materials

• 2020 Provider and Billing Manual (PDF)
• 2021 Provider and Billing Manual (PDF)
  
• Quick Reference Guide (PDF)
• Prior Authorization Guide (PDF)
• Secure Portal (PDF)
• Payspan (PDF)
• ICD-10 Information

Medical Management

• Pre-Auth-Needed?
• Inpatient Prior Authorization Fax Form (PDF)
• Outpatient Prior Authorization Fax Form (PDF)
• Grievance and Appeals

Behavioral Health

• Discharge Consultation Form (PDF)
• Electroconvulsive Therapy (ECT) Authorization Request Form (PDF)
• Intensive Outpatient/Day Treatment Form (PDF)
• OTR Completion Tip Sheet (PDF)
• Outpatient Treatment Request Form (PDF)
• Psychological or Neuropsych Testing Authorization Request Form (PDF)
• SMART Goals Fact Sheet (PDF)
• Applied Behavioral Analysis Prior Authorization Request Form (PDF)

Claims and Claim Payment

• Claim Dispute Form (PDF)
• Taxonomy Code Billing Requirement (PDF)
• Common Claim Reject Errors (PDF)
• Electronic Transactions (EDI) (PDF)

Quality

• Practice Guidelines (PDF)
• Quality Improvement (QI)

National Imaging Associates (NIA)

• NIA Transthoracic Echocardiography Announcement (PDF)
• Transthoracic Echocardiography (TTE) Guidelines (PDF)