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blank.  \nOHBCBS-CD-PM-093342-25 October 2025  \nTable of Contents  \nSECTION 1: INTRODUCTION .................................................................................................................... 6  \nWelcome............................................................................................................................................. 6  \nAbout This Manual .............................................................................................................................. 6  \nUpdates and Changes.......................................................................................................................... 7  \nHIPAA and PHI..................................................................................................................................... 7  \nAccessing Information, Forms, and Tools on Our Website ................................................................... 8  \nWebsites ............................................................................................................................................. 8  \nSECTION 2: BASIC PLAN INFORMATION .................................................................................................. 9  \nNondiscrimination Policy..................................................................................................................... 9  \nEqual Program Access on the Basis of Gender ..................................................................................... 9  \nGeneral Contact Information............................................................................................................. 10  \nAnthem and Ohio Department of Medicaid Contacts ........................................................................ 10  \nProvider Representative Information ................................................................................................ 16  \nSECTION 3: PROVIDER RESOURCES ....................................................................................................... 17  \nProvider Self-Service website ............................................................................................................ 17  \nCommunication Listserv Subscriptions .............................................................................................. 17  \nClaims Payment Systemic Error (CPSE) Report ................................................................................... 18  \nProvider Engagement Council............................................................................................................ 18  \nMedical Advisory Committee ............................................................................................................ 18  \nProvider Policies................................................................................................................................ 19  \nOutlier Reimbursement Audit and Review Process ............................................................................ 20  \nClinical Practice Guidelines ................................................................................................................ 28  \nPreventive Healthcare Guidelines...................................................................................................... 29  \nProvider Trainings ............................................................................................................................. 29  \nForms................................................................................................................................................ 29  \nSECTION 4: PROVIDER RESPONSIBILITIES.............................................................................................. 30  \nProvider and Facility Responsibilities .......................................................","cbCaieCUkkblzD38","https://ap.wps.com/l/cbCaieCUkkblzD38","pdf",2190222,129,"English","# SECTION 1: INTRODUCTION\n## Welcome\n## About This Manual\n## Updates and Changes\n## HIPAA and PHI\n## Accessing Information, Forms, and Tools on Our Website\n## Websites\n# SECTION 2: BASIC PLAN INFORMATION\n## Nondiscrimination Policy\n## Equal Program Access on the Basis of Gender\n## General Contact Information\n## Anthem and Ohio Department of Medicaid Contacts\n## Provider Representative Information\n# SECTION 3: PROVIDER RESOURCES\n## Provider Self-Service website\n## Communication Listserv Subscriptions\n## Claims Payment Systemic Error (CPSE) Report\n## Provider Engagement Council\n## Medical Advisory Committee\n## Provider Policies\n## Outlier Reimbursement Audit and Review Process\n## Clinical Practice Guidelines\n## Preventive Healthcare Guidelines\n## Provider Trainings\n## Forms\n# SECTION 4: PROVIDER RESPONSIBILITIES\n## Provider and Facility Responsibilities\n## Restrictions on AI use in Performing a Health Plan Function\n## Privacy and Security\n## Misrouted Protected Health Information\n## Referring to Non-Participating Providers\n## Claims Submission Process for Noncontracted Providers\n## Continued Access to Care\n## Continuity of Care Process\n## Continuity of Care","[{\"question\":\"What topics are covered in the manual’s introduction section?\",\"answer\":\"The introduction explains the purpose of the manual, welcome information, updates and changes, HIPAA and PHI topics, and how to access information, forms, and tools on Anthem’s website.\"},{\"question\":\"Where can providers find resources such as self-service, listservs, and policy information?\",\"answer\":\"Provider resources are collected in SECTION 3, including the Provider Self-Service website, listserv subscriptions, CPSE reporting, provider engagement activities, provider policies, trainings, and forms.\"},{\"question\":\"What provider responsibilities does the manual address?\",\"answer\":\"SECTION 4 covers provider and facility responsibilities, including restrictions on AI use in performing health plan functions, privacy and security rules, handling misrouted PHI, guidance for non-participating providers, claims submission processes for noncontracted providers, and continuity of care requirements.\"}]","OH_CAID_ProviderManual - Provider Manual - October 2025 | PDF",1792710788,325]