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Proveedores
Provider Education Self-Management Tools Certificate Program

These online classes were created to keep you informed on a variety of important topics. Click on a course below to start, and please be sure to complete an attestation once the courses are completed.

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Course What to Expect 
Capacitación y orientación para proveedores Providers who are contracted with Jefferson Health Plans must demonstrate annualy that they are knowledgeable and trained on important topics. Participation in our quarterly provider orientation and training course satisfies this annual requirement. The course offers a detailed overview of Jefferson Health Plans and gives valuable information to meet the needs of our members. Estos son algunos de los temas: product overview; claims filing instructions and best practices; Community HealthChoices program; access and availability standards; Pay-for-Performance and Quality Care Plus; EPSDT standards; and member ID cards.
Timely Filing Protocols and The Reconsideration Process This course provides an overview of our 180-day process for submitting or resubmitting claims for proper review and/or processing within an accurate time frame. Topics also include an overview of the claims reconsideration appeals process with the steps and appropriate documentation needed for review and determination.
Cultural Competency and Linguistic Requirements and Services This course teaches you how to access our clinical programs and resources for patients, including identification and appropriate referral for mental health, drug and alcohol and substance abuse services sensitivity training on diverse and Special Needs populations such as persons who are deaf or hard of hearing and how to obtain sign language interpreters and work effectively with sign language interpreters. The course also includes information on cultural competency and treating Special Needs populations, including the right to treatment for individuals with disabilities.
Complaints, Grievances and Medical Necessity Reviews

Part 1 of this course offers information to providers regarding the Medicaid and CHIP Member Complaint and Grievance process, and how providers can submit Complaint and Grievance requests to the Plan on behalf of their patients who are Plan members.

Part 2 of this course offers information to providers regarding the Medicaid and CHIP Member Utilization Management Authorization request process, and the need to provide supporting clinical documentation and orders required for a medical necessity review.
Overview of 2025 Medicare Advantage Products This course provides an overview of Jefferson Health Plans’ Medicare Advantage Plans, and an understanding of the values/benefits Jefferson Health Plans Medicare offers our members. Topics include copay and prescription drug coverage, and enhanced supplemental benefits such as vision, dental, flex cards, transportation and much more.
Jefferson Health Plans: Individual and Family Plans 2025 Plan Year Overview This course provides a comprehensive overview of the Individual & Family Plans (Affordable Care Act (ACA)), focusing on the key features, benefits, and enrollment process. You’ll gain insight into the 2025 offerings from Jefferson Health Plans (JHP), including the ACA HMO and PPO plans that are available.
Contacto

If you have questions about online courses or provider training, please call 1-888-991-9023 or email providereducation@jeffersonhealthplans.com. 

Preguntas frecuentes

To view the upcoming webinar schedule or download a previous webinar, please click here.

To view additional Jefferson Health Plans tools and resources for providers, click here. You can also log in to the provider portal for more information.

To view our provider manual, which includes up-to-date policies and procedures, click here.

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