Prior Authorization Drug Guidelines
Information about VCHCP's Pharmacy Drug Guidelines.
"Please include this with the Treatment Authorization Request (TAR) form and Clinical
Providers can use these templates along with the TAR and medical information. This
is a good resource on what clinical information is required and this will prevent
requests from getting pended for lack of clinical information.
Find answers to many of your questions about fees, claims, etc.
Required by law, the Department of Managed Health Care has set forth regulations
establishing certain claim settlement practices and the process for resolving claims
disputes for managed care products, such as VCHCP's HMO benefit plans, regulated
The Plan makes a Provider Dispute Resolution mechanism (PDRM) available for providers
to submit disputes to the Plan.
Provider Operations Manual
Information for providers about plan policies, billing procedures, provider responsibilities,
Provider Services Guide
Information for providers regarding direct access, treatment authorization requests,
claims submission, and etc.
Description of VCHCP's specialty drug management program with Accredo.
For enrollees needing continuing care from Specialists and enrollees who require
specialized care over a long period of time.