Credentialing & Participation Guidelines
Documents can be ordered by Name (Alpha Ascending or Descending), Date Added or Number of Hits that the document has received to make it easier to find the document you want to download. Simply click on "Order By" Name, Date or Hits and "Ascendant" or "Descendent" and they will automatically repopulate accordingly.
Standards of Practice & Guidelines
The guidelines below are updated every two years or with changes and mailed to providers. Please call 1.800.624.6961, ext. 7659 or 740.695.7659 if you require another set of guidelines and we will mail them out to you. If you have additional questions about the Disease Management Guidelines, you can call 740.699.6110.
- Guidelines for Preventive Health
- Management of COPD
- Management of Diabetes Mellitus
- Management of Chronic Heart Failure (CHF)
- Substance Abuse
- Management of Depression
- Standards for Patient Records
- Standards for Access to Care and Services
State of West Virginia Credentialing Form
| Date added: | 12/07/2011 |
| Filesize: | 200.53 kB |
| Downloads: | 1452 |
State of Ohio Credentialing Form
| Date added: | 04/19/2010 |
| Filesize: | 580.94 kB |
| Downloads: | 2060 |
Standards for Participation
| Date added: | 09/19/2009 |
| Filesize: | 19.15 kB |
| Downloads: | 1408 |
Listing of credentials required to become a Health Plan Provider.
Users with Adobe Acrobat or Adobe Reader 7.0 or greater will be able to fill out the following form below ONLINE by clicking on the fields or "tabbing" through the fields. Once the information is properly filled out, users then will click "Submit by Email". (Please note: if a field is required, the form will ask you to fill in the required pieces before sending or it will not go through).
If users do not or cannot have the the lastest Adobe Acrobat or Adobe Reader, they can scroll to the bottom of the forms and click on "Print Form". The form will be printed for the user to then manually fill out and return to Health Plan Provider Relations either by mail or fax.
Practitioner's Rights
| Date added: | 09/19/2009 |
| Filesize: | 37.63 kB |
| Downloads: | 1499 |
Information pertaining to Credentialing/Recredentialing, Standards for Participation and Practitioner's Rights.
- Behavioral Health Unit
- Credentialing & Participation Guidelines
- DME Information
- Fraud, Waste & Abuse
- Physician Case Management Referral
- Physician's DM Referral
- Practitioner Procedural Manual
- ProviderFocus Newsletters
- Claims Processing Information
- Reference Fee Schedules
- Electronic Communications
- Find a Provider
Ohio Valley/Mountaineer Region
TF: 1.800.624.6961
Email: hpecs@healthplan.org
Hours: Mon- Fri., 8:30 am to 5:00 pm
HomeTown Region
TF: 1.800.426.9013
Email: hpecs@healthplan.org
Hours: Mon- Fri., 8:00 am to 5:00 pm