Policies & Procedures
Below are Canopy Health’s Policies & Procedures. If you need more help, you may contact your health plan member service department, their phone number is located on your ID card.
Compliance & General Operations
Credentialing
CD-1001 Determining Provider Credentialing Eligibility
CD-1002 Criteria for PCP Categorization
CD-1003 Practitioner Initial Credentialing
CD-1004 Practitioner Recredentialing
CD-1005 Facility Provider Initial and Recredentialing
CD-1006 Criteria for File Review
CD-1007 Ongoing and Performance Monitoring
CD-1007.1 Monitoring of License Status and Expiration
CD-1008 Medical Director and Credentialing Peer Review Committee
CD-1009 Provider Directory Policy
CD-1010 Criteria for HIVAIDS Specialist Categorization
CD-1011 Delegation of Credentialing Process
CD-1012 Reporting to Appropriate Authorities
CD-1013 Appeals Process and Fair Hearing Plan
CD-1014 Notification Regarding Reducing, Suspending, Terminating Practitioner Privileges
Quality Management
Utilization Management
UM AA-001 Network Adequacy and Member Access to Care
UM AER-001 Access to Emergency Services and Post Stabilization Care
UM GA-001 Appeals and Grievances
UM GA-002 Medicare Non-Delegated Appeals Process
UM LA-001 Language Assistance and Culturally Sensitive Accessible Services
UM-001 Access to Info about UM Processes & Auths Policy
UM-002 Addressing Quality Issues identified through UM Processes Policy
UM-003 Behavioral Health Access, Triage & UM Decision Making
UM-004 Canopy Health Alliance Referral Program
UM-005 Consistency and Timeliness for UM Decisions
UM-007 Member & Provider Satisfaction Surveys Policy
UM-010 Standing Referrals Policy
UM-012 Medicare Consistency and Timeliness for UM Decisions
UM-013 Revisions and Reopening Determinations for Medicare Advantage Members
UM-014 Effectuating Medicare Advantage Reconsidered Determinations or Decisions
UM-015 Medicare Member Appointment of Representative (AOR)
UM-016 Acute and SNF Continued Stay Denials and Appeals Policy
UM-017 Medicare Clinical Trials
UM-019 Medicare Dismissal or Withdrawal of an Initial Request
