CHP Programs & Procedures

Capital Health Plan Medical Policies/ Clinical Criteria

• Medical Policies

Utilization Management Topics

• Referrals and Authorizations
• Health Care Decision-Making

Disease Management

• Disease Management Programs

Case Management

• CHP Case Management Program

Grievances and Appeals Information

• for Commercial members (pdf 56.29 kB)
• for Medicare Advantage members

Policy and Procedure Documents:

• Credentialing Procedures (pdf 469.64 kB)
• Medical Record-Keeping Standards (pdf 80.18 kB)

Medicare and Medicaid Fraud and Abuse

• Avoiding Medicare and Medicaid Fraud and Abuse: A Roadmap for New Physicians (pdf 3.34 MB)