Text:

Provider Administrative Manual (PAM)


Table of Contents

Section 1: Introduction

Section 2: Eligibility and Enrollment

Section 3: Provider Policies and Protocols

Section 4: Quality Management

Section 5: Utilization Management

Section 6: Case Management

Section 7: Medicare-Covered Drugs

Section 8: Claims Processing Procedures and Guidelines

Section 9: Compliance

Section 10: Special Investigations Unit

Section 11: Network Participation Responsibilities

Section 12: Member Grievance and Appeal Process

Last updated: 01/2025