A.2	Welcome
A.3	Provider OnLine
A.3	Internet Site
A.4	How to UseThis Manual
A.5	Key Contacts
A.5	UPMC Health Plan (Commercial)
A.7	UPMC for Kids (CHIP)
A.8	UPMC for You (Medical Assistance)
A.11	UPMC for Life (Medicare)
A.12	UPMC for Life Specialty Plan
A.13	Other Programs & Government Contacts
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B.2	Provider Rights, Responsibilities, & Roles
B.10	Provider Standards & Requirements
B.17	Accessibility Standards
B.21	Referrals & Coordination of Care
B.26	Hospital Guidelines
B.30	Provider Disputes
B.35	Provider Credentialing
B.40	Provider Sanctioning
B.42	Provider Termination
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C.2	Products at a Glance
C.3	Enhanced Access Health Maintenance Organization (EAHMO)
C.4	Enhanced Access Point-of-Service (EAPOS)
C.6	Preferred Provider Organization (PPO)
C.7	Exclusive Provider Organization (EPO)
C.8	UPMC Consumer Advantage (Consumer Directed Health Care Programs)
C.10	Covered Benefits
C.20	Benefit Exclusions
C.21	Services That May Be Covered With Certain Restrictions
C.22	Complaints & Grievances
C.23	Complaint Procedures
C.26	Grievance Procedures
C.33	Quick Reference Guide
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D.2	At a Glance
D.4	Covered Benefits
D.10	Benefit Exclusions
D.12	Member Complaint & Grievance Procedures
D.17	Member Rights & Responsibilities
D.19	UPMC for Kids Quick Reference Guide
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E.2	At a Glance
E.3	Medical Assistance Managed Care in Pennsylvania
E.5	Covered Benefits
E.20	Expanded Benefits
E.21	Services Already Approved by Another Plan or Medical Assistance
E.22	Services Not Covered
E.24	The EPSDT Program
E.29	Member Complaint & Grievance Procedures
E.33	UPMC for You Quick Reference Guides
E.34	EPSDT Periodicity Schedule
E.35	Dental Periodicity Schedule
E.36	Structured Screening tools for Developmental Delays and Autism Spectrum
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F.2	At a Glance
F.3	UPMC for Life HMO
F.5	UPMC for Life PPO
F.7	UPMC for Life Specialty Plan
F.8	UPMC Health Plan Medicare Select
F.10	Benefits & Services for HMO, PPO, and Specialty Plan Members
F.18	Services Not Covered
F.19	Member Appeals & Grievances
F.22	Quick Reference Guide
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G.2	At a Glance
G.3	When to Notify Medical Management
G.5	Procedures Requiring Predetermination
G.6	Case Management Services
G.7	Special Needs Services
G.9	Health Management Programs
G.11	Clinical & Preventive Health Care Guidelines
G.13	Member & Provider Surveys & Assessments
G.15	Quality Improvement Program
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H.2	At a Glance
H.4	Submission Guidelines
H.9	Claims Documentation
H.17	Codes & Modifiers
H.22	Reimbursement
H.25	Denials & Appeals
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I.2	Member Identification Cards
I.4	Member Rights & Responsibilities
I.5	Identifying Members & Verifying Eligibility
I.8	Determining Primary Insurance Coverage
I.14	Selecting or Changing a Primary Care Provider
I.16	Removing a Member from a Provider's Practice
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J.2	At a Glance
J.3	Pharmacy Policies
J.8	UPMC Health Plan (Commercial) Pharmacy Programs
J.14	UPMC for Kids Pharmacy Programs
J.16	UPMC for You (Medical Assistance) Pharmacy Programs
J.19	UPMC for Life (Medicare) Pharmacy Program
J.22	UPMC for Life Specialty Plan Pharmacy Program
J.23	Benefit Exclusions
J.24	Where to Obtain Prescriptions
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K.2	Glossary of Health Care Terms
K.11	Abbreviations
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L.1	At a Glance
L.3	Providing Behavioral Health Services to UPMC Health Plan members
L.13	About Being a Network Behavioral Health Provider
L.38	Overview of Quality Improvement
L.41	Fraud and Abuse Reporting
L.42	Information about UPMC Health Plan Claims Procedures
L.43	Glossary of Terms and Abbreviations Prepared for Behavioral Health Providers
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