Auth reference list
Which services require prior auth
Drug auths
When meds require prior auth, including injectables
Behavioral health
Auths for BH services
Durable medical equipment
When DME requires authorization
Radiology auths
Requesting high-tech diagnostic studies through AIM
Centers of Excellence
Back & neck pain and transplants
Medical policies
Includes pending policy changes
How to bill
Professional and facility billing; diagnosis coding
Capitation
Services paid per member per month
Procedures and services
Services from after-hours to vaccines
COB
Dual coverage, car accidents, Workers' Comp., Medicare
Code modifiers
Guidance on the most confusing ones
Employee billing
Protecting Priority Health employee privacy
Incentive programs
Performance incentives
Patient-centered medical home
PCMH education and resources
Cost variation reporting
Learn about treatment and cost variations
HealthbyChoiceSM plans
How to complete the 4 different plan forms
