Provider Resources

Resources

Saint Alphonsus Health Plan

Provider Admin

• Provider Administrative Manual
• Provider Portal
• Commonly Used Forms
• Provider Tip Sheet

Prior Authorization

• Prior Authorization List
• Part B Prior Authorization Criteria
• Part D Prior Authorization Criteria 

Member Info

• Member Evidence of Coverage documents
• Member Formulary (Drug List)
• Provider and Pharmacy Directory

Medicare

• Centers for Medicare and Medicaid Services website
• Evaluation and Management Services Guide
• Medicare Managed Care Manual
• Please refer to the CMS website for the most current applicable National Coverage Determination (NCD)/ Local Coverage Determination (LCD)/Local Coverage Article (LCA)/CMS Online Manual System/Transmittals. 

Policies

• Provider Policies and Protocols
• Fraud, Waste and Abuse
• Long Term Acute Care Hospital (LTACH) Reviews
• 30-Day Readmission Review
• Health Equity Analysis
• Interoperability Prior Authorization Metrics 2025
• Use of Cellular Tissue Based Products