Provider Resources

For Providers

Provider Resources

MMA Physician Incentive Program

  1. CCP MPIP Included Service Codes
  2. CCP OBGYN PIP Notification letter
  3. CCP Pediatrician PIP Notification letter

Letter of Interest

  1. CMS LOI Requirements and Email address
  2. CCP LOI Requirements and Email address

CCP

  1. Provider Handbook
  2. Cultural Competency Plan
  3. Authorization Form
  4. BRHPC Prior Authorization Form

CMS MMA T19 Network

  1. Provider Handbook
  2. Cultural Competency Plan
  3. CMS Prior Authorization Request Form
  4. CMS Utilization Management Provider Handbook
  5. CMS Non-Covered Benefit Pricing Provider Alert
  6. CMS Out of State Authorization Request Form
  7. CMS Genetic Test Supplemental Information Request Form
  8. CMS Claims Appeal Form

CMS KidCare T21 Network

  1. Provider Handbook
  2. Cultural Competency Plan
  3. CMS Prior Authorization Request Form
  4. CMS Utilization Management Provider Handbook
  5. CMS Non-Covered Benefit Pricing Provider Alert
  6. CMS Out of State Authorization Request Form
  7. CMS Genetic Test Supplemental Information Request Form
  8. CMS Claims Appeal Form

Memorial Managed Care Plan (HMO)/ Memorial Consumer  Health Plan (PPO)

Prior Authorization form

Adverse and Critical Incident Reporting

PQI Form

Treating Tobacco Use and Dependence

Reference Guide for Clinicians

Psychotropic Medication

Additional Resources

Provider Newsletters

Links

PCP Outreach Letter (Concordia)

Post Partum GYN Program Provider Letter (Concordia)

Provider Alerts

BMI