For Providers

• Overview
• Provider Portal
• Join Our Network
  • Overview
  • Apply to Join Our Network
• Tools and Resources
  • Overview
  • Case Management
    • Overview
    • Complex Case Management Program
    • Transitions of Care Program
    • Disease Management Program
    • Chronic Condition Improvement Program - COPD
    • Case Management Referral
    • Advance Directives
  • Claims
  • Compliance/Fraud, Waste and Abuse (FWA)
    • Overview
    • FDR (First-Tier, Downstream or Related Entity)
    • Compliance and FWA Training
    • FDR Compliance Attestation
    • Compliance Reporting
  • Education and Webinars
  • Forms
  • Helpful Links
  • Pharmacy
    • Overview
    • Rx Prescriber Intervention Programs
  • Provider Admin Manual
  • Quality and Stars
    • Overview
    • Quality Program Overview
    • Stars and HEDIS Overview
    • Medical Record Collection
    • Provider Guide
    • Risk Adjustment
    • Star Measures
  • Special Investigations Unit
  • Utilization Management
    • Overview
    • Hospitals and Inpatient Rehabilitation Centers
      • Overview
      • Notifications to Members
    • Prior Authorization-MediGold
    • Skilled Nursing Facilities
      • Overview
      • Benefit Period
      • Coverage Factors
      • Principles for Determining Skilled Services
      • Supporting Documentation
      • Reimbursement
      • Notifications to Members