Administrative Referrals/Care Direction: Definitions, guidelines, request process and requirements.
Appointment Access and Office Wait Time: Acceptable time standards for patients making appointments and for wait times in the office.
Care Management: Information on Adult Complex Case Management, Advanced Illness Program, Behavioral Health Program, Benefit Appeals, Kidney Care Program, Pediatric Case Management, Pregnancy Program, Transitions of Care Program, and Transplant Case Management.
Centers of Excellence: Information on this program and access to a list of approved providers. Includes bariatric care and transplant programs.
Clinic Site Survey: Procedures for conducting a practitioner office site-related complaint survey.
Medical Policies: Find current versions of Medica utilization management (UM) policies, coverage policies, drug management policies, reimbursement policies, and clinical guidelines.
Medical Record Review: Examination and improvement of medical practice performance.
Member Rights and Responsibilities: Outlines Medica members' legal rights and responsibilities.
Notification Requirements: Requirements and exclusions for inpatient services.
Prior Authorization: Request process, requirements and utilization management.
Quality Guidelines and Improvement: Encompasses a wide range of clinical and service quality initiatives.
Reporting Obligations: Find information and forms intended for Medica network providers to use in responding to reporting obligations required by law, contract or accreditation standards (including those required by the National Committee for Quality Assurance, or NCQA®).