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• Comply with Bravo Health’s Quality Management and Utilization Management programs;
• Use appropriate designated ancillary services;
• Comply with emergency care procedures;
• Comply with Bravo Health access and availability standards as outlined in this manual including
after-hours care;
• Bill Bravo Health on the CMS 1500 claim form or electronically in accordance with Bravo Health
billing procedures;
• When billing ensure that coding is specific enough to capture to acuity and complexity of a
Member’s condition and ensure that the codes submitted are supported by proper documentation
in the medical record;
• Comply with Preventive Screening and Clinical Guidelines;
• Adhere to Bravo Health’s medical record standards as outlined on page 49 of this manual.
THE ROLE OF THE SPECIALIST PHYSICIAN
• Provide specialty services;
• Collaborate with Bravo Health Primary Care Physician to enhance continuity of health care and
appropriate treatment;
• Provide consultative and follow-up reports to the referring physician in a timely manner;
• Comply with access and availability standards as outlined in this manual including after-hours
care;
• Comply with Bravo Health’s pre-authorization process;
• Comply with Bravo Health’s Quality Management and Utilization Management programs;
• Bill Bravo Health on the CMS 1500 claim form in accordance with Bravo Health’s billing
procedures;
• When billing ensure that coding is specific enough to capture to acuity and complexity of a
Member’s condition and ensure that the codes submitted are supported by proper documentation
in the medical record;
• Refer to Bravo Health Participating Providers only;
• Submit encounter information to Bravo Health accurately and timely;
• Adhere to Bravo Health’s medical record standards as outlined on page 49 of this manual.
COMMUNICATION BETWEEN PROVIDERS
• PCP should provide Specialist Physician with relevant clinical information regarding the
Member’s care.
• Specialist P
hysician must provide PCP with information about his/her visit with the Member
in a timely manner.
• PCP must document in the Member’s chart his/her review of any reports, labs or diagnostic
tests received from a Specialist Physician.
PROVIDER MARKETING GUIDELINES
Bravo Health Participating Providers must adhere to the following guidelines with regard to any marketing activities:
• Ensure that any marketing activities are approved in advance by Bravo Health to ensure compliance
with CMS guidelines;
• Ensure that any letters, events, health fairs, etc. are reported to and cleared in advance by Bravo
Health;
• Ensure that any gifts or promotional items are cleared with Bravo Health in advance;
