Provider Manual - Metal-Level Products and Essential Plans

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Section 1 - Introduction to Fidelis Care New York
Section 2 - Member Rights and Responsibilities
Section 3 - Provider Roles and Responsibilities
Section 4 - Primary Care Services
Section 5 - Specialty Provider Services
Section 6 - Women's Health Provider Responsibilities
Section 7 - Standards for Medical Record Documentation
Section 8 - Emergency and Acute Services
Section 9 - Provider Credentialing and Termination
Section 10 - Health Care Performance Evaluation
Section 11 - Referral and Pre-Authorization
Section 12 - Billing and Claims
Section 12A - Affidavit Form
Section 12B - Corrected Claims Form
Section 13 - Provider Appeals
Section 13B - Provider Invoice Fax Form
Section 14 - Member Grievances and Complaints
Section 15 - Family Planning
Section 16 - Enrollment and Eligibility
Section 17 - Product Information
Section 18 - Authorizations for Non-Participating Providers
Section 19 - Behavioral Health

Appendix I - Authorization Grid
Appendix II - Pharmacy Services
Appendix III - Vaccines Coverage
Appendix IV - CAGE A Instrument
Appendix V - Depression Screen: Patient Health Questionnaire
Appendix VI - HIV Names Reporting and Partner Notification Regulations
Appendix VII - New York State Child/Teen Health Program
Appendix VIII - Clinical Guidelines
Appendix IX - Sample ID Cards
Appendix X - Columbia Suicide Severity Rating Scale
Appendix XI - Generalized Anxiety Disorder 7-Item (GAD-7) Scale