Preferred Health Systems

Section Banner Image

Update Provider Information

Provider Update Form
Use this form to change and/or update your tax I.D. number, physical address and phone, or fax numbers.  Please save the form to your computer, complete the relevant information, and email it to your provider representative with your W-9 form if necessary.


NOTICES

2013 CAHPS Summary
PDF
Letter to Providers - Readmission Review Policy
PDF
Letter and FAQs regarding the Coventry Readmission Review Policy in effect as of July 1, 2013. This policy applies to all facilities reimbursed at MS-DRG pricing methodology.
Notice of Change: Network Coverage Determination
PDF
Triad Pain Management Prior Authorization
PDF


"NETWORK CONNECTION" PROVIDER NEWSLETTER

Provider Newsletter - December 2013
PDF
Provider Newsletter - November 2013
PDF
Provider Newsletter - October 2013
PDF
Provider Newsletter - September 2013
PDF
Provider Newsletter - August 2013
PDF
Provider Newsletter - July 2013
PDF


QUALITY IMPROVEMENT PROGRAM

2013 QI Program Overview
PDF
An updated overview of Coventry's 2013 QI program
2013 QI Program Description
PDF
A thorough description of the Coventry Health Care Midwest Region QI policies and procedures
2012 QI Program Evaluation
PDF
2012 Annual Evaluation of Coventry's Quality Improvement Program


Case Management Program

Coventry Health Care Case Management
PDF


Disease Management Program

Coventry Health Care Disease Management
PDF


Provider Manual - Effective August 2013

Preferred Health Systems Provider Manual
PDF | 1,049 KB
Preferred Health Systems (A Coventry Health Care Plan) Provider Manual, updated August 2013


PRESCRIPTION INFORMATION

Prescription Documents
Access the following information by clicking the link to the left: List of preferred pharmaceuticals; list of medications requiring prior authorization or step-therapy; list of medications that have limits or quotas; copay requirements and medications to which they apply; procedures for step-therapy, prior authorization, generic substitution, and preferred-brand and therapeutic interchange; information on use of pharmaceutical procedures; criteria used to evaluation new medications for the formulary; process for medication coverage exception.



Forms and Policies

Employer Driven Fee Schedule
PDF
HMO Referral Form
PDF
PHS Prior Authorization List - HMO & POS Plan
PDF
PHS Prior Authorization List - PPO Plan
PDF
Medical Claim Form
PDF
OB Notification Form
PDF
Referral Waiver Form
PDF
Administrative Reconsideration Form
PDF
HMO/POS PCP Member Dismissal Form
PDF
Authorized Representative Form
PDF
Members' Rights and Responsibilities
PDF
Rights and responsibilities distributed to Coventry plan members


CLINICAL PRACTICE GUIDELINES

Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and Other Atherosclerotic Vascular Disease
PDF | 2,276 KB
Source: American Heart Association, Circulation: Journal of the American Heart Association, 2011 AHA/ACCF
Heart Disease and Stroke Statistics2013 Update
PDF | 8,121 KB
Source: American Heart AssociationA Report From the American Heart Association
What is Carotid Artery Disease?
PDF | 458 KB
Source: National Heart, Lung and Blood Institute
Guidelines for Heart Failure and Management in Adults
PDF | 993 KB
Source: American Heart Association
What is Heart Failure?
PDF | 169 KB
Source: National Heart, Lung and Blood Institute
2010 Comprehensive Heart Failure Guidelines
PDF | 993 KB
Source: Society of America Comprehensive Heart Failure
Your Guide to Lowering Your Blood Pressure with DASH
PDF | 845 KB
Source: National Heart, Lung and Blood Institute
Evaluation and Management of Chronic Kidney Disease
PDF | 4,442 KB
Source: Kidney Disease: Improving Global Outcomes (KDIGO)
What's New About the NEW CKD Guidelines?
PDF | 62 KB
Source: National Kidney Foundation
About Chronic Kidney Disease
PDF | 497 KB
Source: National Kidney Foundation
Diagnosis and Management of Asthma
PDF | 6,259 KB
Source: National Institute of Health
Asthma in Adults: Fact Sheet
PDF | 102 KB
Source: American Lung Association
Asthma in Children: Fact Sheet
PDF | 101 KB
Source: American Lung Association
Global Strategy for the Diagnosis, Management and Prevention of COPD
PDF | 1,644 KB
Source: 2013 Global Initiative for Chronic Obstructive Lung Disease
COPD Fact Sheet
PDF | 57 KB
Source: American Lung Association
Diabetes Clinical Practice Guidelines
PDF | 935 KB
Source: American Diabetes Association
Diabetes Fact Sheet
PDF | 1,579 KB
Source: National Center for Chronic Disease Prevention and Health
Snapshot of Diabetes
PDF | 61 KB
Source: Center for Disease Control and Prevention
Major Depression
PDF | 40 KB
Source: American Psychiatric Association
Bipolar Disorder
PDF | 120 KB
Source: American Psychiatric Association


Preventive Health Guidelines

Preventive Care Coverage
PDF
Ages 0 - 10 Years
PDF
Ages 11 - 24 Years
PDF
Ages 24 - 65 Years
PDF
Ages 65 and Older
PDF
Pregnant Women
PDF


Behavioral Health Services


The information in this section is designed to help facilitate behavioral health and substance abuse referrals, answer questions regarding authorization and referral procedures and provide the materials you need to do so easily.
Mental Health and Substance Abuse
PDF
Psychological Testing Prior Authorization Form
PDF
Behavioral Health/Substance Abuse Laboratory Tests Form
PDF
Outpatient Treatment Review Form
PDF
Initiating a Referral

PDF

Authorization Process
PDF
Laboratory Tests
PDF

directprovider

Manage all your Coventry health plan needs at our secure, one-stop, multi-functional provider portal.

 

Login or Register Now


Get Adobe Reader

© Copyright 2008-2014 Coventry Health Care