Provider Manual

We would like to welcome you to ONECare by Care1st Health Plan Arizona, Inc. (ONECare). As a provider you play a very important role in the delivery of health care services to our members. The ONECare Provider Manual is intended to be used as a guideline for the provision of covered services to ONECare members. This manual contains policies, procedures, and general reference information, including minimum standards of care which are required of ONECare Providers.

Click on the appropriate section title below to view and/or print the contents of a particular section or view the Entire Manual

TABLE OF CONTENTS:

SECTION I - INTRODUCTION

SECTION II - QUICK REFERENCE CONTACT LIST

SECTION III - PROVIDER ROLES AND RESPONSIBILITIES

SECTION IV - MEMBER RIGHTS & RESPONSIBILITIES

SECTION V - ELIGIBILITY AND ENROLLMENT

SECTION VI - COVERED SERVICES

SECTION VII - BEHAVIORAL HEALTH SERVICES

SECTION VIII - PHARMACY

SECTION IX - PROVIDER AND MEMBER APPEALS

SECTION X - MEDICAL OPERATIONS

SECTION XI - QUALITY MANAGEMENT

SECTION XII - BILLING, CLAIMS AND ENCOUNTERS

SECTION XIII - FRAUD, WASTE AND ABUSE