Mother and father in park with daughter and son

Provider News... Please check the Providers page under What’s New for updates on our ERA, EFT and Provider Disclosure processes.

Attention PACT Program registered offices:
Click this link to log onto our PACT text message site for OB/GYNs.
Tools for Primary Care Clinicians
NCQA Quality Improvement Connection
Your educational resource and gateway to CME Performance (PI) activities.
Cultural Competency CME Courses
Practitioner Application Process
1. Disclosure Form Requirement
2. Practitioner Application Screening Form
Facility / Organization Application Process
1. Disclosure Form Requirement
2. Facility Questionnaire
Billing Alerts
1. Attention Coders & Billers
2. Consultation Codes
3. ICD-9-CM Coding Persistency
4. Provider NDC Billing Notice
APPEALS AND RESUBMISSIONS
1. Provider Appeal Form
2. Claim Resubmission Form
3. Claims Reconsideration vs Provider Appeal Process
4. Timely Filing Criteria
CLINICAL POLICIES AND CLINICAL DECISIONS
1. Clinical Policy Bulletins
2. Clinical Decision Making Hierarchy
CLINICAL PRACTICE GUIDELINES
1. Treatment of Alcohol and Other Drug Dependence
2. Treating Patients with Asthma
3. Treating Patients with COPD
4. Treating Chronic Heart Failure in Adults
5. Treating Patients with Diabetes
6. Routine Prenatal and Postpartum Care
7. Treating Patients with Major Depressive Disorder
8. Treating Patients with Major Depressive Disorder in Primary Care
BEHAVIORAL HEALTH
1. Behavioral Health Provider Forms
2. Behavioral Health Benefit Conversion form
SPECIALTY PHARMACY INFORMATION
1. August 2007 Specialty Pharmacy Provider Letter
2. October 2008 Specialty Pharmacy Update Letter
3. DPCI Specialty Pharmacy Authorization Form
PROVIDER NEWSLETTERS
PROVIDER MANUAL
PROVIDER FORMS
1. Electronic Remittance (ERA) Enrollment Form
2. Physical Health Provider Forms
3. Prior Authorization Form
4. Cancelled Check Request Form
5. Member Non Compliance Form
6. Perinatal Risk Assessment Form
7. Credentialing Application Addendum
8. EFT Auth Form
National Coding FAQ's
Frequently Asked Questions (FAQ)
1. Common Questions
PROVIDER RESOURCES
RESOURCES A - C
1. Anticipatory Guidance Guidelines
2. Ask Me 3
3. Cultural Competence
RESOURCES D - H
1. Deficit Reduction Act Policy
2. DPCI Contract Attachment
3. Depression Health Questionnaire
4. Diabetes Self Management Program
RESOURCES M - N
1. Member Roster Access Changes
2. Member Rights and Responsibilities
3. MedSolutions Announcement Letter to Providers
4. MedSolutions Quick Reference Guide
5. National Coding FAQ's
RESOURCES P - Z
1. DPCI Urgent Care Providers
2. Pharmacy PA Guidelines
3. Sample Remittance Advice
4. Provider Refund process
Link to NPI Registry
EFT Authorization Enrollment Form
Provider Disclosure Statement

Pharmacy Prior Authorization Guidelines