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	2013 SHL Provider Summary Guide 2013 SHL Provider Summary Guide - Searchable PDF 1. INTRODUCTION 2. OVERVIEW 3. FREQUENTLY CALLED NUMBERS 4. PROVIDER ADMINISTRATIVE REQUIREMENTS AND RESOURCES 5. CREDENTIALING 6. BENEFITS & ELIGIBILITY 7. UTILIZATION MANAGEMENT 8. CLINICAL GUIDELINES 9. MEDICAL DIRECTOR 10. QUALITY ASSURANCE 11. QUALITY IMPROVEMENT PROGRAM 12. CLAIMS 13. CONFIDENTIALITY 14. MEMBERS ACCESS TO MEDICAL RECORDS 15. MEMBERS’ RIGHTS AND RESPONSIBILITIES 16. MEMBER COMPLAINTS 17. NEW MEDICAL TECHNOLOGY 18. PHARMACY SERVICES 19. MENTAL HEALTH 20. HEALTH EDUCATION & WELLNESS 21. ADVANCED DIRECTIVES 22. FRAUD WASTE AND ABUSE COMPLIANCE POLICY 23. FREQUENTLY USED FORMS 2013 SHL Provider Summary Guide - Searchable PDF 1. INTRODUCTION 2. OVERVIEW 3. FREQUENTLY CALLED NUMBERS 4. PROVIDER ADMINISTRATIVE REQUIREMENTS AND RESOURCES 5. CREDENTIALING 6. BENEFITS & ELIGIBILITY 7. UTILIZATION MANAGEMENT 8. CLINICAL GUIDELINES 9. MEDICAL DIRECTOR 10. QUALITY ASSURANCE 11. QUALITY IMPROVEMENT PROGRAM 12. CLAIMS 13. CONFIDENTIALITY 14. MEMBERS ACCESS TO MEDICAL RECORDS 15. MEMBERS’ RIGHTS AND RESPONSIBILITIES 16. MEMBER COMPLAINTS 17. NEW MEDICAL TECHNOLOGY 18. PHARMACY SERVICES 19. MENTAL HEALTH 20. HEALTH EDUCATION & WELLNESS 21. ADVANCED DIRECTIVES 22. FRAUD WASTE AND ABUSE COMPLIANCE POLICY 23. FREQUENTLY USED FORMS 2013 SHL Provider Summary Guide - Searchable PDF 1. INTRODUCTION 2. OVERVIEW 3. FREQUENTLY CALLED NUMBERS 4. PROVIDER ADMINISTRATIVE REQUIREMENTS AND RESOURCES 5. CREDENTIALING 6. BENEFITS & ELIGIBILITY 7. UTILIZATION MANAGEMENT 8. CLINICAL GUIDELINES 9. MEDICAL DIRECTOR 10. QUALITY ASSURANCE 11. QUALITY IMPROVEMENT PROGRAM 12. CLAIMS 13. CONFIDENTIALITY 14. MEMBERS ACCESS TO MEDICAL RECORDS 15. MEMBERS’ RIGHTS AND RESPONSIBILITIES 16. MEMBER COMPLAINTS 17. NEW MEDICAL TECHNOLOGY 18. PHARMACY SERVICES 19. MENTAL HEALTH 20. HEALTH EDUCATION & WELLNESS 21. ADVANCED DIRECTIVES 22. FRAUD WASTE AND ABUSE COMPLIANCE POLICY 23. FREQUENTLY USED FORMS 2013 SHL Provider Summary Guide - Searchable PDF 1. INTRODUCTION 2. OVERVIEW 3. FREQUENTLY CALLED NUMBERS 4. PROVIDER ADMINISTRATIVE REQUIREMENTS AND RESOURCES 5. CREDENTIALING 6. BENEFITS & ELIGIBILITY 7. UTILIZATION MANAGEMENT 8. CLINICAL GUIDELINES 9. MEDICAL DIRECTOR 10. QUALITY ASSURANCE 11. QUALITY IMPROVEMENT PROGRAM 12. CLAIMS 13. CONFIDENTIALITY 14. MEMBERS ACCESS TO MEDICAL RECORDS 15. MEMBERS’ RIGHTS AND RESPONSIBILITIES 16. MEMBER COMPLAINTS 17. NEW MEDICAL TECHNOLOGY 18. PHARMACY SERVICES 19. MENTAL HEALTH 20. HEALTH EDUCATION & WELLNESS 21. ADVANCED DIRECTIVES 22. FRAUD WASTE AND ABUSE COMPLIANCE POLICY 23. FREQUENTLY USED FORMS 2013 SHL Provider Summary Guide - Searchable PDF 1. INTRODUCTION 2. OVERVIEW 3. FREQUENTLY CALLED NUMBERS 4. PROVIDER ADMINISTRATIVE REQUIREMENTS AND RESOURCES 5. CREDENTIALING 6. BENEFITS & ELIGIBILITY 7. UTILIZATION MANAGEMENT 8. CLINICAL GUIDELINES 9. MEDICAL DIRECTOR 10. QUALITY ASSURANCE 11. QUALITY IMPROVEMENT PROGRAM 12. CLAIMS 13. CONFIDENTIALITY 14. MEMBERS ACCESS TO MEDICAL RECORDS 15. MEMBERS’ RIGHTS AND RESPONSIBILITIES 16. MEMBER COMPLAINTS 17. NEW MEDICAL TECHNOLOGY 18. PHARMACY SERVICES 19. MENTAL HEALTH 20. HEALTH EDUCATION & WELLNESS 21. ADVANCED DIRECTIVES 22. FRAUD WASTE AND ABUSE COMPLIANCE POLICY 23. FREQUENTLY USED FORMS 2013 SHL Provider Summary Guide - Searchable PDF 1. INTRODUCTION 2. OVERVIEW 3. FREQUENTLY CALLED NUMBERS 4. PROVIDER ADMINISTRATIVE REQUIREMENTS AND RESOURCES 5. CREDENTIALING 6. BENEFITS & ELIGIBILITY 7. UTILIZATION MANAGEMENT 8. CLINICAL GUIDELINES 9. MEDICAL DIRECTOR 10. QUALITY ASSURANCE 11. QUALITY IMPROVEMENT PROGRAM 12. CLAIMS 13. CONFIDENTIALITY 14. MEMBERS ACCESS TO MEDICAL RECORDS 15. MEMBERS’ RIGHTS AND RESPONSIBILITIES 16. MEMBER COMPLAINTS 17. NEW MEDICAL TECHNOLOGY 18. PHARMACY SERVICES 19. MENTAL HEALTH 20. HEALTH EDUCATION & WELLNESS 21. ADVANCED DIRECTIVES 22. FRAUD WASTE AND ABUSE COMPLIANCE POLICY 23. FREQUENTLY USED FORMS 2013 SHL Provider Summary Guide - Searchable PDF 1. INTRODUCTION 2. OVERVIEW 3. FREQUENTLY CALLED NUMBERS 4. PROVIDER ADMINISTRATIVE REQUIREMENTS AND RESOURCES 5. CREDENTIALING 6. BENEFITS & ELIGIBILITY 7. UTILIZATION MANAGEMENT 8. CLINICAL GUIDELINES 9. MEDICAL DIRECTOR 10. QUALITY ASSURANCE 11. QUALITY IMPROVEMENT PROGRAM 12. CLAIMS 13. CONFIDENTIALITY 14. MEMBERS ACCESS TO MEDICAL RECORDS 15. MEMBERS’ RIGHTS AND RESPONSIBILITIES 16. MEMBER COMPLAINTS 17. NEW MEDICAL TECHNOLOGY 18. PHARMACY SERVICES 19. MENTAL HEALTH 20. HEALTH EDUCATION & WELLNESS 21. ADVANCED DIRECTIVES 22. FRAUD WASTE AND ABUSE COMPLIANCE POLICY 23. FREQUENTLY USED FORMS 2013 SHL Provider Summary Guide - Searchable PDF 1. INTRODUCTION 2. OVERVIEW 3. FREQUENTLY CALLED NUMBERS 4. PROVIDER ADMINISTRATIVE REQUIREMENTS AND RESOURCES 5. CREDENTIALING 6. BENEFITS & ELIGIBILITY 7. UTILIZATION MANAGEMENT 8. CLINICAL GUIDELINES 9. MEDICAL DIRECTOR 10. QUALITY ASSURANCE 11. QUALITY IMPROVEMENT PROGRAM 12. CLAIMS 13. CONFIDENTIALITY 14. MEMBERS ACCESS TO MEDICAL RECORDS 15. MEMBERS’ RIGHTS AND RESPONSIBILITIES 16. MEMBER COMPLAINTS 17. NEW MEDICAL TECHNOLOGY 18. PHARMACY SERVICES 19. MENTAL HEALTH 20. HEALTH EDUCATION & WELLNESS 21. ADVANCED DIRECTIVES 22. FRAUD WASTE AND ABUSE COMPLIANCE POLICY 23. FREQUENTLY USED FORMS 2013 SHL Provider Summary Guide - Searchable PDF 1. INTRODUCTION 2. OVERVIEW 3. FREQUENTLY CALLED NUMBERS 4. PROVIDER ADMINISTRATIVE REQUIREMENTS AND RESOURCES 5. CREDENTIALING 6. BENEFITS & ELIGIBILITY 7. UTILIZATION MANAGEMENT 8. CLINICAL GUIDELINES 9. MEDICAL DIRECTOR 10. QUALITY ASSURANCE 11. QUALITY IMPROVEMENT PROGRAM 12. CLAIMS 13. CONFIDENTIALITY 14. MEMBERS ACCESS TO MEDICAL RECORDS 15. MEMBERS’ RIGHTS AND RESPONSIBILITIES 16. MEMBER COMPLAINTS 17. NEW MEDICAL TECHNOLOGY 18. PHARMACY SERVICES 19. MENTAL HEALTH 20. HEALTH EDUCATION & WELLNESS 21. ADVANCED DIRECTIVES 22. FRAUD WASTE AND ABUSE COMPLIANCE POLICY 23. FREQUENTLY USED FORMS 2013 SHL Provider Summary Guide - Searchable PDF 1. INTRODUCTION 2. OVERVIEW 3. FREQUENTLY CALLED NUMBERS 4. PROVIDER ADMINISTRATIVE REQUIREMENTS AND RESOURCES 5. CREDENTIALING 6. BENEFITS & ELIGIBILITY 7. UTILIZATION MANAGEMENT 8. CLINICAL GUIDELINES 9. MEDICAL DIRECTOR 10. QUALITY ASSURANCE 11. QUALITY IMPROVEMENT PROGRAM 12. CLAIMS 13. CONFIDENTIALITY 14. MEMBERS ACCESS TO MEDICAL RECORDS 15. MEMBERS’ RIGHTS AND RESPONSIBILITIES 16. MEMBER COMPLAINTS 17. NEW MEDICAL TECHNOLOGY 18. PHARMACY SERVICES 19. MENTAL HEALTH 20. HEALTH EDUCATION & WELLNESS 21. ADVANCED DIRECTIVES 22. FRAUD WASTE AND ABUSE COMPLIANCE POLICY 23. FREQUENTLY USED FORMS 2013 SHL Provider Summary Guide - Searchable PDF 1. INTRODUCTION 2. OVERVIEW 3. FREQUENTLY CALLED NUMBERS 4. PROVIDER ADMINISTRATIVE REQUIREMENTS AND RESOURCES 5. CREDENTIALING 6. BENEFITS & ELIGIBILITY 7. UTILIZATION MANAGEMENT 8. CLINICAL GUIDELINES 9. MEDICAL DIRECTOR 10. QUALITY ASSURANCE 11. QUALITY IMPROVEMENT PROGRAM 12. CLAIMS 13. CONFIDENTIALITY 14. MEMBERS ACCESS TO MEDICAL RECORDS 15. MEMBERS’ RIGHTS AND RESPONSIBILITIES 16. MEMBER COMPLAINTS 17. NEW MEDICAL TECHNOLOGY 18. PHARMACY SERVICES 19. MENTAL HEALTH 20. HEALTH EDUCATION & WELLNESS 21. ADVANCED DIRECTIVES 22. FRAUD WASTE AND ABUSE COMPLIANCE POLICY 23. FREQUENTLY USED FORMS 2013 SHL Provider Summary Guide - Searchable PDF 1. INTRODUCTION 2. OVERVIEW 3. FREQUENTLY CALLED NUMBERS 4. PROVIDER ADMINISTRATIVE REQUIREMENTS AND RESOURCES 5. CREDENTIALING 6. BENEFITS & ELIGIBILITY 7. UTILIZATION MANAGEMENT 8. CLINICAL GUIDELINES 9. MEDICAL DIRECTOR 10. QUALITY ASSURANCE 11. QUALITY IMPROVEMENT PROGRAM 12. CLAIMS 13. CONFIDENTIALITY 14. MEMBERS ACCESS TO MEDICAL RECORDS 15. MEMBERS’ RIGHTS AND RESPONSIBILITIES 16. MEMBER COMPLAINTS 17. NEW MEDICAL TECHNOLOGY 18. PHARMACY SERVICES 19. MENTAL HEALTH 20. HEALTH EDUCATION & WELLNESS 21. ADVANCED DIRECTIVES 22. FRAUD WASTE AND ABUSE COMPLIANCE POLICY 23. FREQUENTLY USED FORMS 2013 SHL Provider Summary Guide - Searchable PDF 1. INTRODUCTION 2. OVERVIEW 3. FREQUENTLY CALLED NUMBERS 4. PROVIDER ADMINISTRATIVE REQUIREMENTS AND RESOURCES 5. CREDENTIALING 6. BENEFITS & ELIGIBILITY 7. UTILIZATION MANAGEMENT 8. CLINICAL GUIDELINES 9. MEDICAL DIRECTOR 10. QUALITY ASSURANCE 11. QUALITY IMPROVEMENT PROGRAM 12. CLAIMS 13. CONFIDENTIALITY 14. MEMBERS ACCESS TO MEDICAL RECORDS 15. MEMBERS’ RIGHTS AND RESPONSIBILITIES 16. MEMBER COMPLAINTS 17. NEW MEDICAL TECHNOLOGY 18. PHARMACY SERVICES 19. MENTAL HEALTH 20. HEALTH EDUCATION & WELLNESS 21. ADVANCED DIRECTIVES 22. FRAUD WASTE AND ABUSE COMPLIANCE POLICY 23. FREQUENTLY USED FORMS 2013 SHL Provider Summary Guide - Searchable PDF 1. INTRODUCTION 2. OVERVIEW 3. FREQUENTLY CALLED NUMBERS 4. PROVIDER ADMINISTRATIVE REQUIREMENTS AND RESOURCES 5. CREDENTIALING 6. BENEFITS & ELIGIBILITY 7. UTILIZATION MANAGEMENT 8. CLINICAL GUIDELINES 9. MEDICAL DIRECTOR 10. QUALITY ASSURANCE 11. QUALITY IMPROVEMENT PROGRAM 12. CLAIMS 13. CONFIDENTIALITY 14. MEMBERS ACCESS TO MEDICAL RECORDS 15. MEMBERS’ RIGHTS AND RESPONSIBILITIES 16. MEMBER COMPLAINTS 17. NEW MEDICAL TECHNOLOGY 18. PHARMACY SERVICES 19. MENTAL HEALTH 20. HEALTH EDUCATION & WELLNESS 21. ADVANCED DIRECTIVES 22. FRAUD WASTE AND ABUSE COMPLIANCE POLICY 23. FREQUENTLY USED FORMS 2013 SHL Provider Summary Guide - Searchable PDF 1. INTRODUCTION 2. OVERVIEW 3. FREQUENTLY CALLED NUMBERS 4. PROVIDER ADMINISTRATIVE REQUIREMENTS AND RESOURCES 5. CREDENTIALING 6. BENEFITS & ELIGIBILITY 7. UTILIZATION MANAGEMENT 8. CLINICAL GUIDELINES 9. MEDICAL DIRECTOR 10. QUALITY ASSURANCE 11. QUALITY IMPROVEMENT PROGRAM 12. CLAIMS 13. CONFIDENTIALITY 14. MEMBERS ACCESS TO MEDICAL RECORDS 15. MEMBERS’ RIGHTS AND RESPONSIBILITIES 16. MEMBER COMPLAINTS 17. NEW MEDICAL TECHNOLOGY 18. PHARMACY SERVICES 19. MENTAL HEALTH 20. HEALTH EDUCATION & WELLNESS 21. ADVANCED DIRECTIVES 22. FRAUD WASTE AND ABUSE COMPLIANCE POLICY 23. FREQUENTLY USED FORMS 2013 SHL Provider Summary Guide - Searchable PDF 1. INTRODUCTION 2. OVERVIEW 3. FREQUENTLY CALLED NUMBERS 4. PROVIDER ADMINISTRATIVE REQUIREMENTS AND RESOURCES 5. CREDENTIALING 6. BENEFITS & ELIGIBILITY 7. UTILIZATION MANAGEMENT 8. CLINICAL GUIDELINES 9. MEDICAL DIRECTOR 10. QUALITY ASSURANCE 11. QUALITY IMPROVEMENT PROGRAM 12. CLAIMS 13. CONFIDENTIALITY 14. MEMBERS ACCESS TO MEDICAL RECORDS 15. MEMBERS’ RIGHTS AND RESPONSIBILITIES 16. MEMBER COMPLAINTS 17. NEW MEDICAL TECHNOLOGY 18. PHARMACY SERVICES 19. MENTAL HEALTH 20. HEALTH EDUCATION & WELLNESS 21. ADVANCED DIRECTIVES 22. FRAUD WASTE AND ABUSE COMPLIANCE POLICY 23. FREQUENTLY USED FORMS 2013 SHL Provider Summary Guide - Searchable PDF 1. INTRODUCTION 2. OVERVIEW 3. FREQUENTLY CALLED NUMBERS 4. PROVIDER ADMINISTRATIVE REQUIREMENTS AND RESOURCES 5. CREDENTIALING 6. BENEFITS & ELIGIBILITY 7. UTILIZATION MANAGEMENT 8. CLINICAL GUIDELINES 9. MEDICAL DIRECTOR 10. QUALITY ASSURANCE 11. QUALITY IMPROVEMENT PROGRAM 12. CLAIMS 13. CONFIDENTIALITY 14. MEMBERS ACCESS TO MEDICAL RECORDS 15. MEMBERS’ RIGHTS AND RESPONSIBILITIES 16. MEMBER COMPLAINTS 17. NEW MEDICAL TECHNOLOGY 18. PHARMACY SERVICES 19. MENTAL HEALTH 20. HEALTH EDUCATION & WELLNESS 21. ADVANCED DIRECTIVES 22. FRAUD WASTE AND ABUSE COMPLIANCE POLICY 23. FREQUENTLY USED FORMS 2013 SHL Provider Summary Guide - Searchable PDF 1. INTRODUCTION 2. OVERVIEW 3. FREQUENTLY CALLED NUMBERS 4. PROVIDER ADMINISTRATIVE REQUIREMENTS AND RESOURCES 5. CREDENTIALING 6. BENEFITS & ELIGIBILITY 7. UTILIZATION MANAGEMENT 8. CLINICAL GUIDELINES 9. MEDICAL DIRECTOR 10. QUALITY ASSURANCE 11. QUALITY IMPROVEMENT PROGRAM 12. CLAIMS 13. CONFIDENTIALITY 14. MEMBERS ACCESS TO MEDICAL RECORDS 15. MEMBERS’ RIGHTS AND RESPONSIBILITIES 16. MEMBER COMPLAINTS 17. NEW MEDICAL TECHNOLOGY 18. PHARMACY SERVICES 19. MENTAL HEALTH 20. HEALTH EDUCATION & WELLNESS 21. ADVANCED DIRECTIVES 22. FRAUD WASTE AND ABUSE COMPLIANCE POLICY 23. FREQUENTLY USED FORMS 2013 SHL Provider Summary Guide - Searchable PDF 1. INTRODUCTION 2. OVERVIEW 3. FREQUENTLY CALLED NUMBERS 4. PROVIDER ADMINISTRATIVE REQUIREMENTS AND RESOURCES 5. CREDENTIALING 6. BENEFITS & ELIGIBILITY 7. UTILIZATION MANAGEMENT 8. CLINICAL GUIDELINES 9. MEDICAL DIRECTOR 10. QUALITY ASSURANCE 11. QUALITY IMPROVEMENT PROGRAM 12. CLAIMS 13. CONFIDENTIALITY 14. MEMBERS ACCESS TO MEDICAL RECORDS 15. MEMBERS’ RIGHTS AND RESPONSIBILITIES 16. MEMBER COMPLAINTS 17. NEW MEDICAL TECHNOLOGY 18. PHARMACY SERVICES 19. MENTAL HEALTH 20. HEALTH EDUCATION & WELLNESS 21. ADVANCED DIRECTIVES 22. FRAUD WASTE AND ABUSE COMPLIANCE POLICY 23. FREQUENTLY USED FORMS 2013 SHL Provider Summary Guide - Searchable PDF 1. INTRODUCTION 2. OVERVIEW 3. FREQUENTLY CALLED NUMBERS 4. PROVIDER ADMINISTRATIVE REQUIREMENTS AND RESOURCES 5. CREDENTIALING 6. BENEFITS & ELIGIBILITY 7. UTILIZATION MANAGEMENT 8. CLINICAL GUIDELINES 9. MEDICAL DIRECTOR 10. QUALITY ASSURANCE 11. QUALITY IMPROVEMENT PROGRAM 12. CLAIMS 13. CONFIDENTIALITY 14. MEMBERS ACCESS TO MEDICAL RECORDS 15. MEMBERS’ RIGHTS AND RESPONSIBILITIES 16. MEMBER COMPLAINTS 17. NEW MEDICAL TECHNOLOGY 18. PHARMACY SERVICES 19. MENTAL HEALTH 20. HEALTH EDUCATION & WELLNESS 21. ADVANCED DIRECTIVES 22. FRAUD WASTE AND ABUSE COMPLIANCE POLICY 23. FREQUENTLY USED FORMS 2013 SHL Provider Summary Guide - Searchable PDF 1. INTRODUCTION 2. OVERVIEW 3. FREQUENTLY CALLED NUMBERS 4. PROVIDER ADMINISTRATIVE REQUIREMENTS AND RESOURCES 5. CREDENTIALING 6. BENEFITS & ELIGIBILITY 7. UTILIZATION MANAGEMENT 8. CLINICAL GUIDELINES 9. MEDICAL DIRECTOR 10. QUALITY ASSURANCE 11. QUALITY IMPROVEMENT PROGRAM 12. CLAIMS 13. CONFIDENTIALITY 14. MEMBERS ACCESS TO MEDICAL RECORDS 15. MEMBERS’ RIGHTS AND RESPONSIBILITIES 16. MEMBER COMPLAINTS 17. NEW MEDICAL TECHNOLOGY 18. PHARMACY SERVICES 19. MENTAL HEALTH 20. HEALTH EDUCATION & WELLNESS 21. ADVANCED DIRECTIVES 22. FRAUD WASTE AND ABUSE COMPLIANCE POLICY 23. FREQUENTLY USED FORMS 2013 SHL Provider Summary Guide - Searchable PDF 1. INTRODUCTION 2. OVERVIEW 3. FREQUENTLY CALLED NUMBERS 4. PROVIDER ADMINISTRATIVE REQUIREMENTS AND RESOURCES 5. CREDENTIALING 6. BENEFITS & ELIGIBILITY 7. UTILIZATION MANAGEMENT 8. CLINICAL GUIDELINES 9. MEDICAL DIRECTOR 10. QUALITY ASSURANCE 11. QUALITY IMPROVEMENT PROGRAM 12. CLAIMS 13. CONFIDENTIALITY 14. MEMBERS ACCESS TO MEDICAL RECORDS 15. MEMBERS’ RIGHTS AND RESPONSIBILITIES 16. MEMBER COMPLAINTS 17. NEW MEDICAL TECHNOLOGY 18. PHARMACY SERVICES 19. MENTAL HEALTH 20. HEALTH EDUCATION & WELLNESS 21. ADVANCED DIRECTIVES 22. FRAUD WASTE AND ABUSE COMPLIANCE POLICY 23. FREQUENTLY USED FORMS 2013 SHL Provider Summary Guide - Searchable PDF 1. INTRODUCTION 2. OVERVIEW 3. FREQUENTLY CALLED NUMBERS 4. PROVIDER ADMINISTRATIVE REQUIREMENTS AND RESOURCES 5. CREDENTIALING 6. BENEFITS & ELIGIBILITY 7. UTILIZATION MANAGEMENT 8. CLINICAL GUIDELINES 9. MEDICAL DIRECTOR 10. QUALITY ASSURANCE 11. QUALITY IMPROVEMENT PROGRAM 12. CLAIMS 13. CONFIDENTIALITY 14. MEMBERS ACCESS TO MEDICAL RECORDS 15. MEMBERS’ RIGHTS AND RESPONSIBILITIES 16. MEMBER COMPLAINTS 17. NEW MEDICAL TECHNOLOGY 18. PHARMACY SERVICES 19. MENTAL HEALTH 20. HEALTH EDUCATION & WELLNESS 21. ADVANCED DIRECTIVES 22. FRAUD WASTE AND ABUSE COMPLIANCE POLICY 23. FREQUENTLY USED FORMS 2013 SHL Provider Summary Guide - Searchable PDF 1. INTRODUCTION 2. OVERVIEW 3. FREQUENTLY CALLED NUMBERS 4. PROVIDER ADMINISTRATIVE REQUIREMENTS AND RESOURCES 5. CREDENTIALING 6. BENEFITS & ELIGIBILITY 7. UTILIZATION MANAGEMENT 8. CLINICAL GUIDELINES 9. MEDICAL DIRECTOR 10. QUALITY ASSURANCE 11. QUALITY IMPROVEMENT PROGRAM 12. CLAIMS 13. CONFIDENTIALITY 14. MEMBERS ACCESS TO MEDICAL RECORDS 15. MEMBERS’ RIGHTS AND RESPONSIBILITIES 16. MEMBER COMPLAINTS 17. NEW MEDICAL TECHNOLOGY 18. PHARMACY SERVICES 19. MENTAL HEALTH 20. HEALTH EDUCATION & WELLNESS 21. ADVANCED DIRECTIVES 22. FRAUD WASTE AND ABUSE COMPLIANCE POLICY 23. FREQUENTLY USED FORMS 2012 SHL Prior Auth Requirements SHL Clinical Guidelines SHL@YourService Information We're@YourService Provider Tutorial SHL@YourService Prior Authorization Tutorial We're@YourService Administrator Account Reference Guide Guide for Internet Browser Adjustments for We're @YourService Submission Access We're@YourService Provider Tutorial SHL@YourService Prior Authorization Tutorial We're@YourService Administrator Account Reference Guide Guide for Internet Browser Adjustments for We're @YourService Submission Access We're@YourService Provider Tutorial SHL@YourService Prior Authorization Tutorial We're@YourService Administrator Account Reference Guide Guide for Internet Browser Adjustments for We're @YourService Submission Access We're@YourService Provider Tutorial SHL@YourService Prior Authorization Tutorial We're@YourService Administrator Account Reference Guide Guide for Internet Browser Adjustments for We're @YourService Submission Access FDA/CMS Non-Matched NDC List CMS - Notice of Medicare Non-Coverage (NOMNC)

Online Provider Information

Additional information will be added to this site periodically. Providers and their administrative staff may find this information helpful. Please check back often to view updates.

Providers interested in becoming a contracted provider with any of the Sierra Health Services, Inc. networks (ie: Health Plan of Nevada, SmartChoice/ Medicaid Nevada Check-Up, Sierra Health and Life, Sierra Health-Care Options, Prime Health, Sierra At Work, Northern Nevada Health Network), must submit a Letter of Intent.

A Letter of Intent must be on office letterhead and include the following information:

Provider's specialty
Provider's social security number
Practice address (physical & billing), phone and fax number
Tax identification number
Networks for consideration
Contact name and phone number

You may fax Letters of Intent to (702) 266-8809 Attention: Contract Specialist. Or you may mail Letters of Intent to:

Network Development and Contract

Attn: Contract Specialist

P. O. Box 15645

Las Vegas, NV 89114.

If your practice is already contracted and a new provider is going to join your group, you must notify us immediately. Please complete the Provider Add Request Form and fax it to (702) 266-8809, Attention: Contract Specialist.

Once your request for network participation has been approved, we will consider your application for credentialing.

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