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The manual also references corrected claims and check runs.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What information is required for prior authorization through clinical operations?",{"text":68,"@type":64},"Providers should submit benefit and service authorizations through the Prior authorization section under Clinical Operations and use the correct contact and phone option shown. The manual also points to portal access for submitting and managing authorizations.",{"name":70,"@type":61,"acceptedAnswer":71},"Where are pharmacy-related determinations and appeals handled?",{"text":72,"@type":64},"Pharmacy coverage, determinations (including prior authorization), and pharmacy redeterminations (appeals) are handled via the pharmacy contact details in Key Contacts. 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Medicare Advantage Plans Provider Manual | 2024  \nIn Michigan:  \nCCA Medicare Excel (HMO), and CCA Medicare Maximum (HMO D-SNP)  \nCCA Health Michigan , Inc. | Medicare Advantage Plans Provider Manual | Rev 1/2024  \nTABLE OF CONTENTS  \nSECTION 1: Key Contacts .........................................................................................................................................2  \nSECTION 2: Introduction to CCA Health Michigan, Inc.............................................................................................7  \nSECTION 3: Payment.................................................................................................................................................8  \nSECTION 4: Provider Information ............................................................................................................................ 10  \nSECTION 5: Primary Care Providers ....................................................................................................................... 18  \nSECTION 6: Medical Management ..........................................................................................................................20  \nSECTION 7: Quality Management ...........................................................................................................................24  \nSECTION 8: Pharmacy.............................................................................................................................................29  \nSECTION 9: Claims ..................................................................................................................................................36  \nSECTION 10 : Risk Adjustment .................................................................................................................................43  \nSECTION 11: Medical Records ................................................................................................................................44  \nSECTION 12: Medicare Compliance, Fraud, Waste, and Abuse .............................................................................45  \nSECTION 13: Glossary and Acronyms ....................................................................................................................52  \nSECTION 1: Key Contacts  \n\n| Contact | Telephone | Fax | Email |  | Website/Portal |\n| --- | --- | --- | --- | --- | --- |\n| Claims, Covered Services, and Prior Authorization |  |  |  |  |  |\n| Provider Services\u003Cbr>• Refunds and escalations\u003Cbr>• Corrected claims\u003Cbr>• Claims status\u003Cbr>• Claim receipt\u003Cbr>• Check runs\u003Cbr>• Covered services\u003Cbr>• Authorization status\u003Cbr>• Service denials/appeals status\u003Cbr>• General questions\u003Cbr>New providers, contracting, and EDI electronic billing setup or problems\u003Cbr>VPay/SDS\u003Cbr>• EDI 835 transactions\u003Cbr>SSI / ClaimsNet Clearinghouse • EDI 837 transactions\u003Cbr>CCA Health Michigan Attention: Claims PO Box 21063 Eagan, MN 55121 | 855‐959‐5855\u003Cbr>844-343-3692\u003Cbr>800-820-4774 |  |  |  |  |\n| Member Services |  |  |  |  |  |\n| General questions\u003Cbr>Member appeals | 855‐959‐5855, | 813-513-7323 |  |  |  |\n\n\n| Contact | Telephone | Fax | Email |  | Website/Portal |\n| --- | --- | --- | --- | --- | --- |\n| • Service denials (process, how to respond)\u003Cbr>Member benefits\u003Cbr>• Member information, coverage |  |  |  |  |  |\n| Member Appeals & Grievances |  |  |  |  |  |\n| Member appeals\u003Cbr>Member grievances | 855‐959‐5855, | 813-513-7323 |  |  |  |\n| Member Enrollment |  |  |  |  |  |\n| Outreach and marketing\u003Cbr>• Referrals for potential members | 734-984-4537 |  |  |  |  |\n| Clinical Operations |  |  |  |  |  |\n| Prior authorization\u003Cbr>• Benefit and service authorizations | 855-959‐5855, Option 3 | 813-775-2609 |  | Portal:\u003Cbr>[rhpprovider.prod.healthaxis.net/login](rhpprovider.prod.healthaxis.net/login) |  |\n| Dental Benefit Administrator: Delta Dental |  |  |  |  |  |\n\n\n| Contact | Telephone | Fax | Email |  | Website/Portal ","cbCaivp59sf2dxOI","https://ap.wps.com/l/cbCaivp59sf2dxOI","pdf",1100496,58,"English","# SECTION 1: Key Contacts\n# SECTION 2: Introduction to CCA Health Michigan, Inc\n# SECTION 3: Payment\n# SECTION 4: Provider Information\n# SECTION 5: Primary Care Providers\n# SECTION 6: Medical Management\n# SECTION 7: Quality Management\n# SECTION 8: Pharmacy\n# SECTION 9: Claims\n# SECTION 10 : Risk Adjustment\n# SECTION 11: Medical Records\n# SECTION 12: Medicare Compliance, Fraud, Waste, and Abuse\n# SECTION 13: Glossary and Acronyms","[{\"question\":\"How can providers submit or manage claims and covered services?\",\"answer\":\"Use the claims contact listed in the Key Contacts section and follow guidance covering covered services, prior authorization, claim receipt, and claims status. The manual also references corrected claims and check runs.\"},{\"question\":\"What information is required for prior authorization through clinical operations?\",\"answer\":\"Providers should submit benefit and service authorizations through the Prior authorization section under Clinical Operations and use the correct contact and phone option shown. The manual also points to portal access for submitting and managing authorizations.\"},{\"question\":\"Where are pharmacy-related determinations and appeals handled?\",\"answer\":\"Pharmacy coverage, determinations (including prior authorization), and pharmacy redeterminations (appeals) are handled via the pharmacy contact details in Key Contacts. Pharmacy administrators such as Optum Rx are referenced with their associated responsibilities.\"}]","CCA Health Michigan, Inc. Medicare Advantage Plans Provider Manual - Rev 1/2024 | PDF",1790422664,146]