Initial Orientation and Training for Network Providers

For newly contracted providers seeking a more comprehensive orientation and training.

What to Expect: contracted providers are required to annually demonstrate their knowledge and training on key topics. Participation in our provider orientation and training course fulfills this annual requirement. This course provides a comprehensive overview of our plans and essential information to meet our members' needs. Topics covered include: current updates, product overview, member ID cards, credentialing, claims filing instructions and best practices, online tools, Community HealthChoices program, Pay-for-Performance and Quality Care Plus, EPSDT standards, and much more.

Annual Training for Network Providers (ATP)

For established contracted providers who have already completed the initial comprehensive orientation and training and looking for a more concise yet impactful and informative session.

What to Expect: contracted providers are required to annually demonstrate their knowledge and training on key topics. Participation in our provider orientation and training course fulfills this annual requirement. This course provides a comprehensive overview of our plans and essential information to meet our members' needs. Topics covered include: current updates, product overview, member ID cards, credentialing, claims filing instructions and best practices, online tools, Community HealthChoices program, Pay-for-Performance and Quality Care Plus, EPSDT standards, and much more.

Annual Training for Ancillary Providers (ATAP)

For ancillary contracted providers who are seeking a more comprehensive orientation and training.

What to expect: our comprehensive training session is designed for contracted ancillary providers and will cover a range of topics, including current updates, claim filing instructions and best practices, credentialing, utilization management and prior authorization, Evicore, and other valuable resources. The training is tailored to the services provided by the following provider types:

• Radiology
• Home Care
• Home Hospice
• Home Infusion
• Transportation
• Home Health Aide
• Ambulatory Surgical Center
• Skilled Nursing Facility (SNF)
• PT, OT and Speech Therapy
• Durable Medical Equipment

DSNP Model of Care Training

For all contracted and non-contracted providers serving Dual Eligible Special Needs Plan (D-SNP) members. Annual MOC training must be completed to comply with CMS requirements.

What to expect: this training ensures providers understand the specialized care and services offered to dual-eligible beneficiaries.

At least one representative per care team location must complete the training, submit the attestation, and distribute the materials with all DSNP care team members.

Training is available year-round via our online course or live webinars. Completion is only recognized once the attestation is submitted - either at the end of the online course or via the DSNP Attestation link following a webinar.

Timely Filing Protocols and The Reconsideration Process

What to expect: this course provides an overview of our 180-day process for submitting or resubmitting claims for proper review and/or processing within an accurate time frame. Topics also include an overview of the claims reconsideration appeals process with the steps and appropriate documentation needed for review and determination.

Complaints, Grievances and Medical Necessity Reviews

What to expect: Part 1 of this course offers information to providers regarding the Medicaid and CHIP Member Complaint and Grievance process, and how providers can submit Complaint and Grievance requests to the Plan on behalf of their patients who are Plan members.

Part 2 of this course offers information to providers regarding the Medicaid and CHIP Member Utilization Management Authorization request process, and the need to provide supporting clinical documentation and orders required for a medical necessity review.