Policies and Procedures

Claims

• Definition of a Clean Claim 
• Electronic Claim Submission
• External Claims Provider Appeal Form
• External Claims Provider Appeal Process Level 1
• External Claims Provider Appeal Process Levels 2-3
• Overpaid Claims
• Plan Coverage and Eligibility Determination
• Provider Communication – Claims

Compliance

• Auditing and Monitoring
  

Credentialing

• Credentialing – Recredentialing

• Credentialing Committee

• Credentialing Committee Confidentiality Statement Form

• Credentialing Records and Confidentiality

HCBS

• HCBS Non-Residential Provisional Provider Application
• HCBS Residential Provisional Provider Application
• Home and Community-Based Provisional Approval
  

Incident Reporting

• Incident Reporting Policy
• Incident Reporting Form
  

Provider Network

• Communication
• Grievances and Appeals
• Notification of Summit Pointe Provider Network Changes
• Ongoing Compliance Monitoring
• Written Notice of Termination Contractual Provider
  

SWMBH Policy and Procedures