HMO Facility Manual

This manual was developed to provide you and your staff with administrative guidelines with respect to the HMO Facility network.

This manual will be updated, as needed, and these updates will be posted to this site. These files are in a PDF format and require Adobe Reader to open and view them.

If you have trouble opening the files or accessing the information, please contact your Provider Contracting Representative for additional options in receiving the latest version of this manual.


HMO Facility Manual Download Section
Table of Contents and Welcome  
A. Support Services 
B. Provider Roles and Responsibilities  
D. Referral Notification Program 
E. Preauthorization 
F. Filing Claims 
G. Quality Improvement Program 
H. Disease Management Programs, Case Management Program, Clinical Practice Guidelines, and Bridges to Excellence 
I. Behavioral Health Services 
J. Other Information 
K. Hospital Acquired Conditions and Serious Reportable Events