ASH is committed to making available evidence-based, clinical decision-making guidelines to support the provision of healthcare services. The following Clinical Practice Guidelines have been developed through a review of currently available clinical information that includes:

• Clinical outcome studies in peer-reviewed published literature
• Regulatory status of the procedure
• Evidence-based guidelines of public health research agencies
• Evidenced-based guidelines
• Views of practitioners practicing in relevant clinical areas
• Other relevant factors.

American Specialty Health, Inc., makes no representation and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Practice Guidelines. The description, background and positions reflected in the Clinical Practice Guidelines (including any reference to a specific provider, product, process or service by name, trademark, or manufacturer) constitutes the opinion of the clinical quality committees of American Specialty Health, Inc., upon review of available evidence and are made without intent to defame. American Specialty Health, Inc., makes no representation that these opinions are endorsed by any Healthcare Provider society or association. American Specialty Health expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information, including correction of any factual error(s).

The conclusion that a particular procedure is acceptable does not constitute a representation or warranty that this service is covered for a member’s benefit plan. The member’s benefit plan determines coverage.

I accept the above disclaimer

How can ASH help expand my patient base?

Contracted practitioners and providers (collectively contracted providers) will be listed in the health plan and ASH's directories, both online and hard copy. Members are encouraged to seek services from contracted providers as they will have lower out-of-pocket expenses. Remember, these new patients will also refer by word of mouth to friends and family.

Will ASH expand in my area?

Yes, ASH does not deny any provider's application based on geographic limitations. While we do not actively recruit in areas where we have a sufficient number of providers, we do process all applications received, as well as pursue member and client nominations for additional providers in support of existing, and new business opportunities.

Are there fees to join ASH?

No. There are no fees associated with joining ASH and your participation is non-exclusive. This means that you can expand your patient base with ASH and keep your current relationships with other vendors.

What is covered under your services agreement and Operations Manual?

Your services agreement and Operations Manual encompass an array of information pertinent to interactions with ASH. They also outline mutual objectives to deliver health care services and health improvement services to meet members' needs in a manner that promotes high levels of member and client satisfaction. Such standards of performances require that services be rendered in an evidence-based, clinically effective and efficient way. Upon joining ASH, it is your responsibility to be familiar with and comply with ASH clinical policies, guidelines, and administrative requirements. The agreement and operations manual contain helpful information, including definitions, processes, timelines, and required forms. The Clinical Practice Guidelines and the Clinical Performance System programs are also outlined, which aid providers to work effectively with ASH. Click HERE for more information about ASH Clinical Practice Guidelines.

Does a member need a medical referral before coming to see me?

Referral requirements vary by specialty and health plan. For many of our specialty programs a medical referral is not required. These ASH programs usually allow patients direct access to the participating ASH provider of the patient's choice. However, ASH does manage some benefit programs where medical referral may be required by the health plan and/or State regulations. For massage therapy, medical referrals may be required by the health plan or State requirement. For physical, occupational, and speech therapy medical referrals are required prior to treating a patient; however, referrals are not required to be submitted to ASH.

Does ASH contract with health plans for Workers' Compensation or Auto Med Pay plans?

If ASH administers a benefit for Workers' Compensation, auto med pay, or third-party personal injury in your area, providers typically will have the opportunity to elect to participate in that type of a plan. Contracted providers will not be automatically included, but you will be able to agree through a separate amendment to your services agreement to participate in these programs. California providers will be automatically added to these programs, but can elect to not participate in them at the time of credentialing.

Does ASH require providers to obtain approval for services I render?

ASH has a Clinical Performance System (CPS) that allows some clinical services to be provided before medical necessity review is needed. For most newly contracted providers, ASH allows the first five (5) office visits in the calendar year (check your services agreement and Operations Manual for possible California exceptions) to be reimbursed without submission of medical necessity review. When the submission of a medical necessity review form is required, you have 180 days from the first date of service requiring review to submit this form.

Why should I use ASH standardized forms?

ASH requires the use of our standardized forms to ensure that the minimum required information is submitted and can be evaluated equitably. The use of ASH standardized forms is also essential in allowing us to respond to your submissions accurately and promptly.

Where can I find information about the criteria required for billing claims?

Because each health plan is different and each has unique requirements, we provide a document called a Client Summary for each of our health plan clients. The Client Summaries are information sheets that define the requirements of each health plan. They will give you information such as:

• Who to call for eligibility and benefit information
• Whether a referral is required
• Whether medical necessity review is required
• Where to send claims
• What services are covered
• Which fee schedules are applicable

Does ASH have specific Clearinghouses that are already set up to send claims electronically?

Yes, please see the Clearinghouse List [pdf].

How are fee schedules developed, and how often do they change?

Each fee schedule is determined by the client and ASH. Fee schedules are set at a level intended to make specialty health services attractive to potential health plan purchasers. All fee schedules are reviewed annually, and changes are communicated to our contracted providers. The reimbursement amounts are based on multiple factors driven by publically available rate information, client market information, and ASH reimbursement experience.

Does ASH credential practitioners and how long is the process?

Yes. The ASH credentialing process is certified by NCQA (National Committee for Quality Assurance) and accredited by URAC, and we follow all state and federal credentialing guidelines, including time frames. The credentialing process must be done within 180 days; however, ASH typically completes within 60 days. It is important that you return all needed documents within a timely manner to prevent a possible credentialing cancellation. If you have any questions regarding ASH's clinical guidelines at any time during the credentialing process, you can refer to the Clinical Practice Guidelines section on www.ASHLink.com or contact ASH for assistance at 800.972.4226, option 2.

Can ASH use my current CAQH information?

Yes. Once we receive your ASH services agreement signature page, we will be able to download your application directly from CAQH. Be sure to give global access to American Specialty Health so we have authorization to download your application.

How do I check the status of my application?

To check the status of your application, please call Practitioner Contract Administration at 800.972.4226, option 2, and one of our credentialing representatives will assist you.

Will I need to be recredentialed?

Yes. To comply with regulatory and accreditation requirements, we are obligated to recredential our practitioners every two to three years, depending on state-specific requirements and accreditation standards. Therefore, you will need to be recredentialed for us to comply with this industry requirement.

How do I join ASH?

If you are interested in becoming an ASH provider, please call 888.511.2743 and one of our representatives will assist you.

How do I learn more about ASH's Medical Necessity Review process?

Medical necessity verification decisions are evaluated against established clinical guidelines supported by credible scientific evidence that meets industry standard research quality criteria, and is adopted by an ASH clinical peer-review committee. Additional information about ASH's Medical Necessity Review process can be found on our public portal www.ASHLink.com by searching for Medical Necessity Review process.

How do I learn more about ASH's Clinical Practice Guidelines?

When developing Clinical Practice Guidelines (CPGs) ASH evaluates current peer-reviewed research literature, generally accepted standards of practice, and existing practice parameters. ASH CPGs provide the evidence base from which peer-reviewers evaluate the quality, quantity, and appropriateness of services proposed or billed. ASH has reviewed the scientific literature and developed over 130 Clinical Practice Guideline documents, which are published on our public website, www.ASHLink.com, and are available by searching for Clinical Practice Guidelines. ASH obtains initial and annual review and approval of CPGs by ASH's clinical committees, consisting of practicing, participating clinicians.

Does ASH have an online support portal?

Yes. ASHLink is our online portal. ASHLink is a free, secure and confidential dynamic website available to contracted providers. On ASHLink you can access information and conduct business online, saving time verifying member eligibility and submitting forms and claims. By using ASHLink to submit claims you can receive payments quickly and efficiently, while increasing office revenues and lowering overhead costs. An incentive is also available when a least 50 percent of your transactions are processed through ASHLink.

Other resources available on ASHLink include:

• Value Added Program discounts
• Client Summaries
• Forms
• Operations Manual
• services agreement
• Notifications/Newsletters
• Education Library

Can I receive payment through Direct Deposit?

Yes. Our Direct Deposit program provides a faster way to receive payment and access to your funds. Our turn-around-time is typically 4 days or less with the payment deposited directly to the bank account of your choice.

Other benefits of Direct Deposit include:

• A direct deposit bonus payment
• Easy tracking on ASHLink
• Faster access to your funds
• Time savings - no going to the bank

If you still have questions, feel free to contact us.