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Our Document Library has provider manuals, formularies, and other supporting documentation to help you provide superior service to your patients. Click here to visit the pre-authorization section of the website for forms and instructions.
If you need help, please contact us.
QI Confidentiality
Privacy and health information is a very important topic for health plans, providers, and members. The law sets rules and limits on who can look at and receive a member’s information.
Information can be used and shared:
- with your insurer for health care operations such as quality improvement activities
- to pay for health care
- to protect the public’s health, such as reporting information when the flu is in your area
- to make required reports to the police, such as reporting gunshot wounds
- with the member on request.
Health plans and providers are required to have a written privacy procedure, including a description of staff that has access to protected information, how it will be used, how it will be stored and when it may be disclosed. In addition, all employees need to be trained on the privacy policies and procedures on a periodic basis.
When HealthAmerica conducts the yearly medical record review, the on-site audit tool includes a question on whether the office has a policy and conducts training with the staff on confidentiality.
HealthAmerica has written policies for confidentiality. A copy of this policy can be obtained form your HealthAmerica Provider Relations representative or found in the Provider Manual
Clinical Practice Guidelines
Clinical practice guidelines are evidence-based processes, procedures, and methodologies determined to be the most currently recognized practices to follow in treating and managing patients with specific diseases and illnesses. Published by professional speciality groups, these guidelines have been researched, reviewed, and recommended to our participating provider network by HealthAmerica. The guidelines are meant to assist you in the evaluation and treatment of your patients' health, but are not intended to replace clinical judgment or create a mandatory course of action for all patients who experience a similar condition.
Chronic Obstructive Pulmonary Disease (COPD) (2008)
Congestive Heart Failure (2007)
Coronary Artery Disease (2008)
These guidelines, which are reviewed and updated at least every other year, are for both contracted providers and our members.
DOCUMENT LIBRARY
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Pregnancy Assessment Form
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Please remember to:
- Identify the member’s Risk Factors by checking the appropriate box.
- Complete the comment section with information relevant to the Risk Factor.
- Signature is required of member and provider of care.
- Complete the assessment form in its entirety.
- Mail or fax the completed form to the address or fax number located at the bottom of the form.
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CCM Referral
- Use this form to refer members for Complex Case Management programs.
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Practice Safety Assessment Form
- This link is a web-based "Physician Practice Patient Safety Assessment" to help doctors evaluate how well they run their offices, including tools to help them improve their systems for tracking medication use and safety, transferring information to other doctors and communicating with patients. The self-assessment program can be downloaded by any physician office for free.
Pennsylvania’s Autism Insurance Law, Act 62
Central Pennsylvania Provider Manual
Northwestern Pennsylvania Provider Manual
Southeastern Pennsylvania Provider Manual
Western Pennsylvania and Ohio Provider Manual
Facility Manuals
- email page
- print page
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