Introduction The Provider Manual is intended for Network Providers in Valley Health Plan (VHP). The Provider Manual contains policies and procedures that describe how to submit claims and encounter data, to obtain authorizations and referrals, and to understand covered services. All Network Providers should use this Manual as the primary reference for the policies and guidelines of Valley Health Plan. This Manual contains policies, procedures and guidelines for Valley Health Plan's product lines: • •
Valley Health Plan Commercial Santa Clara Family Health Plan–Network 2 o Medi-Cal Managed Care o Healthy Families o Healthy Kids
The VHP Provider Manual is divided into the 16 sections: Introduction Authorization & Referrals Claims Summary of Benefits Primary Care Ancillary Services for Chiropractic and Acupuncture Mental Health and Substance Abuse Urgent and Emergency Care Case Management Pharmacy Health Education Provider Relations (Including Dispute Process) Quality Management HIPAA Forms and Attachments Glossary of Terms
SECTION 1: INTRODUCTION
Section 1: Section 2: Section 3: Section 4: Section 5: Section 6: Section 7: Section 8: Section 9: Section 10: Section 11: Section 12: Section 13: Section 14: Section 15: Section 16:
You can access the Provider Manual at our website: www.valleyhealthplan.org or for a hard copy please contact the Provider Relations Department at (408) 885-2221. This Manual provides a summary of the important features of Valley Health Plan. The Member Handbook, Evidence of Coverage and the Summary of Benefits for each product line contain more detailed information on the exact terms and conditions of VHP coverage and on the benefits, limitations and exclusions.
www.valleyhealthplan.org rev.2020
Section 1
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