Policies and Guidelines

We know how complicated the health insurance and managed care industry has become. We also understand how that complexity can impact patient care, as well as your bottom line.

That's why we're offering all of our policies and guidelines in one, easy-to-access section. Here you'll find all you need to know about our products, services, claims and reimbursement process, drug therapy guidelines, and patient safety resources.

We're here to help you. That's our bottom line.

doctor explains drug therapy guidelines to member

Prior Authorization

Commerical and Medicare Advantage members may require prior authorization (preauthorization) to recieve a service. Obtaining a prior authorization helps us pay claims faster with no denied charges, or unexpected costs to our members.

Learn More

Access Drug Therapy Guidelines

To ensure thorough consideration of both quality-of-care and economic issues, some drugs require prior authorization.

We work with a committee of local physicians and pharmacists to identify medications that should require this kind of authorization and to develop the medical criteria used to determine when coverage is appropriate.