Health Plus Provider Manual

Manual of Policies and Procedures for Providers

The Health Plus Provider Manual includes an overview of our plan and its services, updated referral, authorization and claims information, and a concise yet comprehensive summary of quality improvement, HIPAA and other regulatory guidelines. There are separate chapters with information specific to each provider type: primary care, specialist, OB/GYN, behavioral health, laboratory, radiology, pharmacy and ancillary. Other chapters, such as those covering authorization, billing and utilization management issues, are meant to address all Health Plus contracted providers.

Should you have any questions about the information presented in this manual, please contact your Provider Relations Associate, the Health Plus Provider Care Center (1-800-450-8753), or e-mail us at: providers@healthplus-ny.org.

• Cover Page - (PDF, 1 MB)
• Table of Contents - (PDF, 51KB)
• About Health Plus - (PDF, 230KB)
• Provider Rights and Responsibilities - (PDF, 100KB)
• Provider Relations - (PDF, 57.7KB)
• Primary Care - (PDF, 98.5KB)
• Specialty Care - (PDF, 57.2KB)
• OB/GYN and Family Planning - (PDF, 60.4KB)
• Emergency and Urgent Care - (PDF, 55KB)
• Behavioral Health - (PDF, 90KB)
• Referrals and Authorization - (PDF, 87.4KB)
• Billing and Reimbursement - (PDF, 112KB)
• Utilization Management - (PDF, 109KB)
• Dental and Ancillary Providers - (PDF, 55.3KB)
• Laboratory, Radiology and Pharmacy Providers - (PDF, 83.4KB)
• Quality Improvement, Medical Records, Confidentiality, and HIPAA - (PDF, 71.5KB)
• Public Health Reporting Requirements and Interventions - (PDF, 98.4KB)
• Member Services and Health Education - (PDF, 78.3KB)
• Appendices- Cover Page - (PDF, 6.21KB)
• Appendix 1- Health Plus Benefit Summaries - (PDF, 34.9KB)
• Appendix 2- Medical Record Standards - (PDF, 22.5KB)
• Appendix 3- EOP Code Explanations - (PDF, 38.3KB)
• Appendix 4- Health Plus Participating Laboratories - (PDF, 29.3KB)