Manage your Capital Health Plan practice with CHPConnect.
A medical guideline, also called clinical criteria, is a document with the aim of guiding medical decisions regarding diagnosis, management, and treatment in specific areas of healthcare. Below you will find Capital Health Plan's clincial criteria for our Commercial and Medicare plans.
This section includes CHP-approved clinical practice and preventive guidelines. The guidelines are regularly reviewed and updated by the Quality Improvement Committee. Clinical criteria used in the coverage decision-making process may be accessed on CHPConnect, or with a phone call to Network Services at 850-523-7361.
Check here for Information about CHP's Commercial and Medicare Formularies, Utilization Management Criteria, Pharmacy Network, and safe medication practices.
Capital Health Plan has developed a short training video to explain how a prior authorization request to Prime for medications that process at the pharmacy by clicking here.
The Network Services Department is available to assist the practitioners and facilities that provide service to our members. This folder provides helpful information, newsletters and forms.
Check here for a description of Capital Health Plan programs and company procedures that affect your practice.
Click on the links to find information on Capital Health Plan's Quality Improvement Program, Member Rights and Responsibilities and Patient Safety.