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Provider Resources

Get the tools you need to easily manage your administrative needs, and your keep your focus on the health of your patients. Use the tools and resources below to find the information you need, check member eligibility, submit claims through our secure provider portal, check if pre-authorization is necessary, see the status of a claim and more

 

Home State providers must keep accurate and complete medical records. Such records will enable providers to render the highest quality healthcare service to members. They will also enable Home State to review the quality and appropriateness of the services rendered. Home State will conduct random medical record audits as part of its QI program to monitor compliance with the medical record documentation standards linked below.

The coordination of care and services provided to members, including over/under utilization of specialists, as well as the outcome of such services also may be assessed during a medical record audit. Home State will provide written notice prior to conducting a medical record review.