Provider Office Administration Manual (POAM)

Assisting You with the Day-To-Day Delivery of CDPHP Medical Benefits

The Provider Office Administrative Manual (POAM) consists of two volumes and is updated annually at a minimum. Please use it as a helpful reference guide to assist you with the day-to-day delivery of CDPHP medical benefits.

Volume I is designed to give you and your staff a comprehensive overview of CDPHP and its current administrative practices.

Volume II is a compendium of our policies and procedures available by logging into your account.

• Provider Office Admin Manual Section 01 - Introduction

• Provider Office Admin Manual Section 02 - Members

• Provider Office Admin Manual Section 03 - Government Programs

• Provider Office Admin Manual Section 04 - Practitioners

• Provider Office Admin Manual Section 05 - Referral & Authorization Process

• Provider Office Admin Manual Section 06 - Waivers

• Provider Office Admin Manual Section 07 - Services

• Provider Office Admin Manual Section 08 - Coordination of Benefits

• Provider Office Admin Manual Section 09 - Claim Submission

• Provider Office Admin Manual Section 10 - Claim Payment & Provider Appeals

• Provider Office Admin Manual Section 11 - Participating Providers

• Provider Office Admin Manual Section 12 - Quality Enhancement

• Provider Office Admin Manual Section 13 - OB/GYN Standards STD/HIV Screening

• Provider Office Admin Manual Section 14 - Utilization Management Program

• Provider Office Admin Manual Section 15 - Disease Management & Wellness Programs

• Provider Office Admin Manual Section 16 - Case Management

• Provider Office Admin Manual Section 17 - Advance Care Planning

• Provider Office Admin Manual Section 18 - Behavioral Health

• Provider Office Admin Manual Section 19 - Participating Facilities

• Provider Office Admin Manual Section 20 - Dental

• Provider Office Admin Manual Section 21 - Enhanced Primary Care

• Provider Office Admin Manual Section 22 - Forms & Literature

• Appendix - Quality Management Program