FLASH: Provider Manuals Available on Your Health Alliance

You 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 procedures and processes, 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

• Preventive care guidelines for all age group

• Members’ rights and responsibilities

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