Foreword		5
Administrative Staff and Office		6
Atlantis Health Plan Executive Committee		7
Definitions		9
Primary Care Physician		11
Selection of a Primary Care Physician by the Atlantis Health Plan Member		11
Changing a Primary Care Physician		11
Membership Card		12
Out-of-Network Facilities and Centers		12
Specialist Physician		13
Specialist as Primary Care Physician		14
Continuity of Care		14
Transitional Care		15
Identification of Atlantis Health Plan Members		15
Covered Services		16
Claim Submission		19
Co-payments		19
Explanation of Payment		19
Medical Record Standards		19
Referrals		21
Standing Referrals		23
Appointments		23
Coverage Arrangements		24
Pre-authorization Process		24
Pre-admission Authorization		25
Concurrent Review Process		25
Discharge Planning		26
Retrospective Review		26
Reconsideration		26
Appeal Procedures		27
Emergency Services		31
Behavioral Health Care		31
Atlantis Health Plan Coordination of Benefits Policy		32
Laboratory Services		33
Credentialing/Recredentialing Guidelines		33
Performance Evaluations		34
Termination of Contract		38
Non-renewal of Contract		41
Referral/Authorization Summary Sheet		42
Procedures Requiring Pre-authorizaton		43
Drugs Requiring Pre-authorization		45
Approved in Office Tests and Procedures		46