FLASH: Provider Manuals Available on Your Health Alliance
November 20, 2018You can find provider manuals for all of our plans on the Forms & Resources page of Your Health Alliance for providers. In them, you’ll find more information about:
- Our Quality Improvement program, including its purpose, goals, objectives, scope, structure, key personnel, and technical resources and systems
- Our care coordination program and how to refer a member
- How to access and request our utilization management and pharmaceutical management criteria
- Affirmative statement about incentives related to UM decision-making
- When decision timeframes begin for nonurgent preservice requests received after business hours
- How to use our pharmacy management processes and procedures, including our formulary, pharmaceutical classes, tier information, preauthorization, managed dose limitations, step-therapy, generic substitution, pharmacy savings programs, and how to request a medical exception
- Our disease management programs, including what we do and how you and your patients can access program services
- A comprehensive list of clinical guidelines, including nonpreventive and preventive, as well as behavioral health for all age groups
- Preventive care guidelines for all age group
- Members’ rights and responsibilities