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The Longevity Health Provider Manual is a comprehe The Longevity Health Provider Manual is a comprehensive, 46-page operational guide for healthcare providers participating in Longevity Health Plan, a Medicare Advantage Institutional Special Needs Plan (ISNP) serving residents of long-term care and skilled nursing facilities across multiple U.S. states. The manual outlines all required policies, procedures, responsibilities, billing standards, clinical protocols, regulatory requirements, and administrative processes that providers must follow to deliver compliant, high-quality care to Longevity members.
⭐ Purpose and Scope
The manual equips contracted providers with clear instructions on how to deliver coordinated, compliant, patient-centered care for a vulnerable population—typically older adults with multiple chronic conditions, high medication needs, mobility limitations, and cognitive impairment. It explains the plan’s model of care, provider expectations, service standards, and operational workflows.
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🧩 Key Components of the Manual
1. Plan Overview & Special Needs Plan Model
Longevity Health Plan is a Medicare Advantage ISNP focused on improving care for nursing home residents. The manual highlights essential concepts about SNP members, including their rights, supplemental benefits, and care coordination needs.
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2. Model of Care (MOC)
The plan’s model of care emphasizes:
Comprehensive health risk assessments
Individualized care planning
Interdisciplinary care team collaboration
Prevention of unnecessary hospitalizations
Improved chronic illness management
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🩺 3. Provider Responsibilities
Providers—including PCPs, specialists, and behavioral health clinicians—must meet strict access, responsiveness, and quality standards such as:
Routine on-site nursing facility visits every 30–60 days
Urgent evaluations within 48 hours
24/7 telephonic availability
Return of urgent calls within 1 hour
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Behavioral health providers must offer care within set timeframes (e.g., 6 hours for emergencies, 10 days for new consults).
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📋 4. Benefits, Services & Coverage Rules
The manual details covered benefits, emergency/urgent service definitions, prior authorization requirements, continuity-of-care policies, and access standards.
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Members must never be balance-billed for covered services, and strict hold-harmless rules apply.
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🏥 5. Credentialing & Provider Network Requirements
The manual explains initial credentialing, recredentialing, required documentation, rights of providers, and conditions that can lead to termination (e.g., sanctions, OIG exclusions).
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It also outlines provider directory accuracy, mandatory updates, and notification timelines.
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🧾 6. Claims Submission, Billing, and Payment Standards
The manual gives detailed billing requirements for:
Clean claim standards
Electronic and paper claim submission
NPI, Tax ID, and taxonomy requirements
Coding rules (CPT/HCPCS/ICD-10)
Timely filing limits
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It also covers pricing, correct coding edits, and how to dispute claim payments.
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⚖️ 7. Compliance, Grievances & Appeals
The manual affirms member rights, outlines complaint and appeal protocols, and describes Longevity’s corporate compliance and fraud-waste-abuse programs.
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⭐ 8. Additional Administrative Policies
Topics include:
Prior authorization and adverse determination rules
Provider marketing restrictions
Member PCP reassignment guidelines
Subrogation and hospice claim handling
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🟦 Summary
Overall, the Longevity Health Provider Manual serves as a complete operating handbook for participating providers. It defines expectations for clinical care, access, patient rights, claims processing, compliance, and communication—all designed to ensure high-quality, safe, regulated, and coordinated care for residents of nursing facilities enrolled in the Longevity Health Plan.
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