Guidelines

• Billing - Guidelines and Requirements: This page will provide links to the specifics of claim submission, coordination of benefits, third party liability, and information on our clearinghouses.  Our Provider Manual can also provide helpful information on billing requirements.
• Clinical-Practice Guidelines are designed to help our providers better manage CUP members with chronic health conditions, such as asthma, cholesterol, hypertension, and depression.   Clinical Guidelines are written to improve the quality and appropriateness of care, serve as educational tools, and improve cost-effectiveness. All CUP guidelines are evidence-based and adopted from recognized, authoritative professional medical associations. These guidelines are designed to assist the clinician in the management of specific conditions.
• Immunization- Guidelines:  Information on this page will give providers information on the Washington State Childhood Vaccine Program, immunization schedules for children and adults, and vaccine information statements.
• Preventive- Health Guidelines reflect recommendations for individuals of average health risk. Providing preventive healthcare services can reduce the incidence of illness, disease, and accidents. Early detection of potentially serious illnesses may also reduce the impact of the illness on the member and improve care outcomes.  The Preventive Health Guidelines present general information about currently recommended preventive health care.           
• Referral- CUP has developed Referral Authorization Guidelines/Criteria to assist providers in determining what services are covered by our member’s health plan.  Searches may be made by individual service type or general category. CUP does NOT accept retroactive requests for authorization. In order to ensure payment, please check eligibility prior to the member receiving services. Out-of-Area and Out-of-Network requests for services require prior authorization.