Federal (United States) · Agency guidance
Chapter 16a
70 sections
70 sections
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 10Introduction
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 20General Requirements
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 30Access to Services
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 30.1General Requirements
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 30.2Access Standards for Full and Partial Network Plans
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 30.3Requirement for Certain Non-Employer PFFS Plans to Use
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 30.3.1General Requirements
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 30.3.2Methodology Used to Identify the Location of Network Areas
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 30.3.3Operational Impact on Non-Employer PFFS Plans
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 30.4Requirement for All Employer/Union Sponsored PFFS Plans to
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 30.4.1General Requirements
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 30.4.2Operational Impact on Employer PFFS Plans
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 40Provider Types: Direct-Contracting, Deemed-Contracting, and
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 40.1Direct-Contracting Providers
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 40.2Deemed-Contracting Providers
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 40.3Non-Contracting Providers
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 50PFFS Terms and Conditions of Payment for Deemed Providers
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 50.1General Requirements
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 50.2Model Terms and Conditions of Payment
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 50.3Process for Submission and Review of Terms and Conditions of
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 50.4Mid-year Changes to Terms and Conditions of Payment
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 50.5Availability of the Terms and Conditions of Payment
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 50.6Terms and Conditions of Payment Identification System
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 60Variations in Payment Rates to Providers
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 70PFFS Payment Rules for Providers and Cost Sharing Rules for
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 70.1General Rules
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 70.2Non-Network PFFS Plan Rules
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 70.2.1General Rules
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 70.2.2Payment Rules for Deemed Providers
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 70.2.3Payment Rules for Direct-Contracting Providers
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 70.2.4Cost Sharing Rules for Members
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 70.2.5Review of Provider Networks
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 70.3Full Network PFFS Plan Rules
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 70.3.1General Rules
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 70.3.2Payment Rules for Direct-Contracting Providers
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 70.3.3Payment Rules for Deemed Providers
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 70.3.4Cost Sharing Rules for Members
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 70.3.5Review of Provider Networks
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 70.4Partial Network PFFS Plan Rules
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 70.4.1General Rules
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 70.4.2Payment Rules for Direct-Contracting Providers
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 70.4.3Payment Rules for Deemed Providers
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 70.4.4Cost Sharing Rules for Members
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 70.4.5Review of Provider Networks
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 80Balance Billing Rules
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 80.1Original Medicare Balance Billing Rules that Apply to Deemed
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 80.2Additional Balance Billing Rules Allowed under PFFS Plans for
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 80.2.1Advance Notice for Hospital Services
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 90Prohibition on Prior Authorization, Prior Notification, and
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 90.1General Requirements
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 90.2Prior Authorization
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 90.3Prior Notification
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 90.4Referrals
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 100Written Advance Organization Determinations
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 110Prompt Payment Requirements
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 120Timely Filing Requirement
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 130Provider Payment Dispute Resolution Process
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 130.1Process for Resolving Provider Payment Disputes through the
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 130.2Process for Resolving Provider Payment Disputes through the
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 140Requirement for PFFS Plans to Provide an Explanation of
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 150Requirement for PFFS Plans to have a Quality Improvement
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 150.1General Requirements
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 150.2Quality Data Collection and Reporting Requirements
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 160PFFS Crosswalk Options
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 160.1Non-Network PFFS Plan Transitioning to a Partial Network
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 160.2Some Counties of a Non-Network PFFS Plan Transitioning to a
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 160.3Non-Network PFFS Plan Transitioning to a Full Network PFFS
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 160.4Some Counties of a Non-Network PFFS Plan Transitioning to a
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 160.5Partial Network PFFS Plan Transitioning to a Full Network
- Medicare Managed Care Manual (Pub. 100-16), Ch. 16a § 160.6Some Counties of a Partial Network PFFS Plan Transitioning to