______________________________________________ Table of Contents
Topic
Page
Introduction to Hometown Health ............................................................................................................... 3 Hometown Health Contact Information ....................................................................................................... 8 Hometown Health Departments ................................................................................................................ 10 Hometown Health Network Logos .............................................................................................................. 14 Member Identification Cards ...................................................................................................................... 15 Hometown Health Utilization Management Program Requirements ........................................................ 31 Claims and Payment Policy Program Requirements ................................................................................... 35 Claims Reconsiderations ............................................................................................................................. 45 Coordination of Benefits and Subrogation ................................................................................................. 47 Claims Payment Policy ................................................................................................................................ 50 Quality Improvement Program Requirements ........................................................................................... 58 Credentialing and Re-credentialing ............................................................................................................ 64 Hometown Health Committees .................................................................................................................. 70 Physician ’ s Role as a Contracted Provider .................................................................................................. 73 Provider Panel Status .................................................................................................................................. 77 Provider Demographics & Information Changes ........................................................................................ 78 Appointments for Members ....................................................................................................................... 80 Member Missed Appointments .................................................................................................................. 83 Link .............................................................................................................................................................. 84 Federal and State Regulations .................................................................................................................... 85