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Provider Manual

Family Health Center Expectation's of Providers

Last Updated on August 28, 2018
  • act in the best interest of members 
  • communicate fully with members regarding their illness, as well as diagnostic and therapeutic options available to them
    • ensure member has access to interpreter services as needed
  • refer members for specialty care or second opinions within the Family Health Center provider network
  • maintain awareness of Family Health Center technology assessment and drug evaluation committee decisions to the extent possible 
  • participate in utilization management and quality improvement initiatives, including allowing Security Health Plan and Family Health Center reasonable access to member medical records 
  • recognize that there are multiple, well-accepted means of diagnosis and treatment for many conditions 
  • inform the medical director when Family Health Center procedures or actions are perceived as threatening the health or well-being of the member 
  • recognize that conflict occasionally occurs between providers and Family Health Center, or members and Family Health Center, and that these should be resolved within the appeals process outlined in Family Health Center documents 
  • understand that Family Health Center does not deny patient care, but simply makes payment decisions based on the member’s coverage through Family Health Center. Members have the right to appeal any decision made by Family Health Center. Information on how to appeal a decision can be reqested by calling Security Health Plan's Customer Service at 1-800-472-2363
  • communicate with members and Family Health Center in a way that assumes that all parties are acting in good faith with the goal being the best care possible for the member 
  • recognize that Family Health Center is obligated to develop policies and procedures on benefit administration and to administer these in a fair and consistent manner even though this occasionally results in denial of payment for individual members 
  • understand that Family Health Center’s objective is to improve access to and quality of health care 
  • refrain from making comments or offering advice on payment issues 
  • refer patients with payment issues to Security Health Plan Customer Service Department at 1-800-472-2363