Procedures and Guidance Documents

DVHA Procedures and Guidance Documents

Clinical Information

• Acute Adult Rehab Prior Authorization Out of Network

• Acute Pediatric Rehab Prior Authorization Out of Network

• Annual Quarterly Code Review

• Clinical Audit Process

• Clinical Guidelines

• CST Benefit Determination

• Quality of Care Concerns Protocol

• Unspecified Diagnosis Code

Employee Training & Education 

• Administration of Agreements Relating to Personally Identifiable Information (PII)

• Hiring Process

• Public Record Request

• Record Retention

• Recording Meetings

Fraud, Waste & Abuse

• Beneficiary Fraud Investigation Process

• Eligibility Termination Requests

• Pharmacy and Prescriber Controlled Substance Monitoring

Medicaid Management Information System

• CCB and Review System Changes

• Fiscal Agent Inactive User Review

• Resolving Suspended Claims

Medicaid Member Information

• Estate Recovery

• Medicaid Deceased Members Review

• Quarterly Quality Assurance Review

• TeamCare Process

Provider Information

• Clinical Laboratory Payment

• Disproportionate Share Hospital Payments

• Durable Medical Equipment (DMEPOS)

• Federally Qualified Health Centers (FQHC) & Rural Health Clinics (RHC) Encounter Rates

• Graduate Medical Education

• Inpatient Prospective Payments System

• Long-Acting Reversible Contraception (LARC) Payment Methodology Process

• Medicaid Data Aggregation and Access Program (MDAAP)

• Medicare Part D BAE LIS

• Non-Emergency Medical Transportation

• Out-of-Network Emergency and Post Stabilization Services Provider Enrollment and Payment Efforts

• Outpatient Prospective Payment System

• Payment Model Design

• Pharmacy Prior Authorization for HUB

• Physician Payment Methodology

• Physician Administered Drug Payment Methodology

• Provider Enrollment and Screening

• Standards of Care

• Utilization Management and Authorization Requirements

• Vermont Medicaid Next Generation Program