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Provider & Practitioner Manual

For your review, our Provider & Practitioner Manual effective January 1, 2008

View/Print sections of the Provider & Practitioner Manual

Adobe PDFTable of Contents
Adobe PDFIntroduction About Keystone Mercy, NPI Number, Telephone Numbers & Definitions
Adobe PDFSection I: Covered Benefits
Adobe PDFSection II: Referral & Authorization Requirements
Adobe PDFSection III: Member Eligibility
Adobe PDFSection IV: Provider Services
Adobe PDFSection V: Primary Care Provider (PCP), Specialist Office Standards & Requirements
Adobe PDFSection VI: Claims & Claims Disputes
Adobe PDFSection VII: Practitioner/Provider Dispute/Appeal Procedures, Member Complaints, Grievances & Fair Hearings
Adobe PDFSection VIII: Quality Management, Credentialing & Utilization Management
Adobe PDFSection IX: Special Needs & Case Management
Adobe PDFSection X: Member Rights & Responsiblities
Adobe PDFSection XI: Regulatory Provisions
Adobe PDFSection XII: Medical Assistance Manual & MA Regulations - Chapter 1101
Adobe PDFAppendix:  
 
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