Showing 41-60 results of 99 total
Documents

Amendment to Evidence of Coverage 2022 (pdf)

… update the Evidence of Coverage document to ensure it is … Scripps Scripps Health Plan These documents can be viewed, downloaded, and … accessing the 'I'm a Member' page: and 'Benefit Information & Forms' …
Documents

How to Become a SHPS Provider (pdf)

… to Provider Relations. Once your documentation is received you will be … County Z Please return completed documents via email: ProviderRelations@scrippshealth.org Subject …
Documents

2021 Annual Scripps Health Plan Mailing (pdf)

… your plan Evidence of Coverage document to ensure it is compliant … clarify the language in the document to make it more user …
Documents

Scripps Health Plan Services Compliance Plan SHP (pdf)

… by Extemal Agencies Accurate & Complete Documentation Coding Program (ACDC) Delegation Oversight … D Investigation and Conective Action Documentation. E. Investigation Closure S) Confidentiality …
Documents

2022 Annual Scripps Health Plan Mailing (pdf)

… plan 's Evidence of Coverage document to ensure it is compliant … clarify the language in the document to make it more user …
Documents

Grievance Resolution Program (pdf)

Scripps Health Plan has a grievance program designed to resolve its members' concerns or complaints in a timely and effective manner. Download this document to learn more about it.
Documents

2018 Amendment to Evidence of Coverage (pdf)

… updates its Evidence of Coverage document to ensure it is clear …
Documents

Electronic Fund Transfer (EFT) Form (pdf)

This document allows you to sign up for electronic fund transfers with Scripps Health Plan Services.
Documents

2020 Amendment to Evidence of Coverage (pdf)

… updates its Evidence of Coverage document to ensure it is clear …
Documents

Care Management Referral Form (pdf)

… issues Form with any supporting documentation may be email or faxed …
Documents

SHPS 1601 Colorectal Cancer Screening (pdf)

… 1601 Scripps Health Plan Services Page 1 of 2 TITLE: … reviewer follows standard referral determination, documentation and notification requirements _ GUIDELINE … 1601 Date: 08/26/21 Page 2 of 2 V. …
Documents

Prior Authorization Request Form (pdf)

The Prior Authorization Request Form allows Scripps Health Plan providers to request approval for services for which authorization is required in advance.
Documents

Corrected Claims Form (pdf)

The Corrected Claim Form allows providers to amend an existing claim, including corrected diagnoses, provider information, charges and more.
Documents

Provider Dispute Resolution (pdf)

The Provider Dispute Resolution Form allows providers to request resolution for disputes concerning payments.
Documents

Statement of Nondiscrimination & Language Access (pdf)

The Statement of Nondiscrimination & Language Access outlines Scripps Health Plan’s policy regarding discrimination and language accessibility options
Documents

Transition of Care Form (pdf)

The Transition of Care Request Form allows members to request coverage for care from an out-of-network doctor willing to accept Scripps Health Plan contracted rates or certain other providers.
Documents

Cerecons New User Application (pdf)

The Information Systems Access Request Form allows affiliated providers to request remote access to Scripps Health Plan computer and information systems.
Documents

Authorization for Release of Protected Health Information (pdf)

Fill out Scripps Health Plan's Authorization of Protected Health Information (PHI) form to have your health records released to specific companies or individuals.
Documents

Confidential Communication Request Form (pdf)

This form allows members to request Scripps Health Plan contact them at an address or telephone number different from what is in their personal records.
Documents

Employee Enrollment Form (pdf)

The Employee Enrollment Form is completed by employers or employees who want to enroll in or make changes to Scripps Health Plan coverage.