Network Policy and Procedures

HMO Policy and Procedures

Policy Name Policy Number Review Date
3rd Trimester Pregnancy IPA Transfer Policy Admin 37 11/14/2024
3rd Trimester Pregnancy IPA Transfer Procedure Admin 37A 12/1/2022
A Woman's Principal Healthcare Policy Admin 44 11/20/2025
Ancillary Hospital Institution Care Transition Exceptions Procedure Admin 11A 1/1/2023
Automatic Approval Process Policy Admin 53 11/20/2025
Automatic Approval Process Procedure Admin 53A 11/20/2025
Contract Management Firms Confidentiality Agreement Policy Admin 14 11/20/2025
Emergency Room Services Policy UM 1 6/24/2025
Emergency Room Services Procedure UM 1A 6/24/2025
HMO Administered Complaints Policy Admin 39 8/28/2025
HMO Administered Complaints Procedure Admin 39A 8/28/2025
HMO Financial Risk Claims Policy Admin 67 11/20/2025
HMO Financial Risk Claims Procedure Admin 67A 11/20/2025
IPA Availability and Accessibility Requirements for Immediate Care Services Policy Admin 83 6/24/2025
IPA Availability and Accessibility Requirements for Immediate Care Services Procedure Admin 83A 6/24/2025
IPA Infertility and Fertility Treatment Guidelines Admin 56 1/22/2026
IPA Guidelines for Member Complaints, Inquiries, Appeals and Grievances Policy Admin 22 6/24/2025
IPA Guidelines for Member Complaints, Inquiries, Appeals and Grievances Procedure Admin 22A 6/24/2025
IPA Process for Establishing Out of Area for Emergency Services Policy Admin 23 6/24/2025
IPA Process for Establishing Out of Area for Emergency Services Procedure Admin 23A 6/24/2025
IPAs Request for Member Transfer Policy Admin 28 6/26/2025
IPAs Request for Member Transfer Procedure Admin 28A 6/26/2025
Member Access to Behavioral Health Services Policy Admin 64 6/23/2025
Member Access to Behavioral Health Services Procedure Admin 64A 6/23/2025
Member Notification Process when a Provider Leaves the IPA Policy Admin 82 4/1/2023
Member Notification Process when a Provider Leaves the IPA Procedure Admin 82A 4/1/2023
Newborn Claim Responsibility Policy Admin 31 6/24/2025
Newborn Claim Responsibility Procedure Admin 31A 6/24/2025
Past Due Claims Process Policy Admin 42 11/20/2025
Past Due Claims Process Procedure Admin 42A 11/20/2025
Physician Access Standards Policy Admin 10 11/20/2025
Primary Care Physician (PCP) Affiliation with Multiple IPAs Policy Admin 2 10/24/2024
Primary Care Physician (PCP) Affiliation with Multiple IPAs Procedure Admin 2A 11/1/2022
Retroactive IPA Member Changes Policy Admin 32 8/28/2025
Retroactive IPA Member Changes Procedure Admin 32A 10/23/2025
Transition of Medical Care Policy Med Support 1 2/12/2026
Transition of Medical Care Procedure Med Support 1A 2/5/2026
UM Fund Challenge Policy Admin 66 6/26/2025
UM Fund Challenge Procedure Admin 66A 6/26/2025


Health Care Delivery Policy and Procedures

Policy Name Policy Number Review Date
Professional Liability Insurance Ref 5 11/20/2025
Provider Handling of Member Inquiries Complaints and Appeals Ref 1 11/20/2025