Provider Resources

As our provider partners, one of Prestige Health Choice's goals is to provide you the resources that you need in a clear, easy-to-find manner. In this section, you'll find items such as member benefit information, credentialing and prior authorization, and how to file a grievance or complaint.

Member information

• Member ID card

• Member complaints, grievances, and appeals

• Member rights and responsibilities

Hospital resources

• Covered services: Expanded benefits guide
  A guide detailing all expanded benefits available to Prestige Health Choice Medicaid members.

• Hospital discharge planning resource guide
  Information that may be helpful in assisting with coordination and authorization as part of a discharge plan.

• Prior authorization
  Information and processes regarding prior authorization for member treatment and services.

Other resources

• Behavioral health and substance use
  Education and support for our network providers.

• Bright Start®
  A maternity case management program providing prenatal and postpartum services.

• Care gaps
  Find missing recommended services (care gaps) for your Prestige Health Choice members right on Availity. 

• Clinical resources
  Clinical practice guidelines and related information for providers.

• Credentialing
  Provider credentialing through the Council for Affordable Quality Healthcare (CAQH).

• Cultural competency
  Understand how to meet the cultural and linguistic needs of our members.

• EHR incentives/meaningful use
  Electronic health records (EHR) overview for providers and healthcare professionals on the HealthIT.gov website.

• Forms
  All the forms you need in one place.

• Healthy Behaviors programs
  Information about programs that reward members for implementing healthy behaviors.

• Let Us Know program
  A partnership with the provider community in the management of chronically ill members.

• Opioid overdose prevention
  Opioid information from the Centers for Disease Control and Prevention (CDC).

• Pharmacy services
  Drug formularies, pharmacy prior authorization process, and other pharmacy resources.

• Prestige analytics tool
  Web-based reporting tool for physicians to review member medical services and HEDIS results. Read the analytics tool instruction manual (PDF).

• Prior authorization
  Information and processes regarding prior authorization for member treatment and services.

• Provider appeals
  How to dispute Prestige Health Choice's policies, procedures, or any aspects of Prestige Health Choice administrative functions.

• Provider manual (PDF)
  Explore the latest provider manual, which now fully incorporates the claims manual.

• Quick reference guide
  Access our Quick Reference Guide for important phone numbers.

• Zika virus benefits and policies
  See coverage and benefit recommendations for the Zika virus.

 If you have questions or require more information, call Provider Services at 1-800-617-5727 to speak to a representative.