2024
Postpartum Care in Collaboration with Latino Connection
October 30, 2024
We are excited to tell you about a collaborative initiative with Latino Connection to provide additional support and outreach to Health Partners Plans Medicaid’s mothers and families in the postpartum period. Latino Connection is a leader in outreach…
Medication Management Support for Medicare Advantage Members
October 25, 2024
Thank you for being a valued provider for members in one or more of our health plans: Health Partners Plans Medicaid, Health Partners Plans CHIP, Jefferson Health Plans Medicare Advantage, and/or Jefferson Health Plans Individual and Family Plans. We…
New Shift Care Authorization Requirements
October 15, 2024
Thank you for being a valued provider for members in one or more of our health plans: Health Partners Plans Medicaid and CHIP plans, Jefferson Health Plans Medicare Advantage, and/or Jefferson Health Plans Individual and Family Plans. Effective Decem…
Medicare Home Care Utilization Review Process
October 14, 2024
Below is an overview of CMS regulatory requirements as it relates to the Medicare home care utilization review process. Jefferson Health Plans is now enforcing these requirements for Medicare Advantage members; compliance is necessary to avoid disrup…
Branding Update (October 2024)
October 9, 2024
As a reminder, in July of 2023 we launched Jefferson Health Plans as our official marketing name for certain Health Partners Plans, Inc. products. While the marketing name changed for certain products, others did not. Our product names that remained …
Innovative Communication Strategies to Close Care Gaps Webinar
October 7, 2024
Jefferson Health Plans and Jefferson Health would like to invite you to an upcoming webinar,Innovative Communication Strategies to Close Care Gaps. The webinar will be held on October 29, 2024, at 12:00 p.m. Our experts will share best practice strat…
Respiratory Illness Information
October 3, 2024
Respiratory illness season has officially begun, which runs during the fall and winter seasons. It’s important that all your patients be protected against respiratory illness during this season. According to the Centers for Disease Control and Preve…
Baby Partners Resources
October 3, 2024
We have developed a resource that provides more details about our Baby Partners program. This flyer can be shared within your office to all clinicians who interact with pregnant and postpartum members. Click here to download the flyer. Visit HPPlans.…
HEDIS 2025 (Measurement Year 2024)
October 2, 2024
HEDIS reporting season is here! We need your support in collecting information from our members’ medical records for the 2024 reporting year. The focus of Healthcare Effectiveness Data and Information Set (HEDIS) is to measure the health plan’s perfo…
Medicare Advantage 2025 Product Overview Webinar Announcement
September 27, 2024
We invite you to an overview of our 2025 Medicare Advantage plans. Our Product Leadership Team will provide a general overview of each Medicare Advantage product and coverage areas, along with important information on our available tools and resource…
Jefferson Health Plans Individual and Family Plans Webinar Announcement
September 27, 2024
We invite you to learn more about our 2025 Jefferson Health Plans Individual and Family Plans on Wednesday, October 9, 2024. Our Marketplace leadership team will provide an overview of our new and existing plans, expanded portfolio, improved cost sha…
Access to Care Plans for Medicare Advantage DSNP Members
September 25, 2024
In an effort to share information more effectively, effective October 1, 2024, Jefferson Health Plans Medicare Advantage DSNP member care plans will be available via the HealthTrio provider portal. To access the member’s individual care plan report,…
Synagis Prior Authorizations
September 17, 2024
Jefferson Health Plans will start the annual Synagis® Prior Authorization process on October 16, 2024, two weeks before the respiratory syncytial virus (RSV) season begins. Synagis® (palivizumab) is a monoclonal antibody indicated to prevent a severe…
LetsGetChecked In-Home Kit Mailing
September 16, 2024
Jefferson Health Plans continues to partner with LetsGetChecked to mail FOBT and/or a combination A1c/kidney health evaluation kit to Medicare Advantage members who are non-compliant with their colorectal cancer screening and/or diabetes management t…
2024 Wellness Rewards Reminder
August 28, 2024
Thank you for being a valued provider for members in one or more of our health plans: Health Partners Plans Medicaid, Health Partners Plans CHIP, Jefferson Health Plans Medicare Advantage, and/or Jefferson Health Plans Individual and Family Plans. Ea…
Annual Orientation and Training Webinar Announcement
August 28, 2024
Thank you for being a valued provider for members in one or more of our health plans: Health Partners Plans Medicaid, Health Partners Plans CHIP, Jefferson Health Plans Medicare Advantage, and/or Jefferson Health Plans Individual and Family Plans. J…
Fall 2024 Provider Checkup newsletter is now available!
August 22, 2024
Thank you for being a valued provider for members in one or more of our health plans: Health Partners Plans Medicaid, Health Partners Plans CHIP, Jefferson Health Plans Medicare Advantage, and/or Jefferson Health Plans Individual and Family Plans. Th…
Introduction to MHK/Portal Mandate for Prior Authorization requests
August 21, 2024
Thank you for being a valued provider for members in one or more of our health plans: Health Partners Plans Medicaid, Health Partners Plans CHIP, Jefferson Health Plans Medicare Advantage, and/or Jefferson Health Plans Individual and Family Plans. We…
You're Invited: HCV Treatment, Monitoring, and Adherence Webinar
August 9, 2024
Thank you for being a Jefferson Health Plans participating provider. We’d like to invite you to an upcoming webinar, Hepatitis C Virus (HCV) Treatment, Monitoring and Adherence. The webinar will be held on August 21 at 12:00 p.m. The Centers for Dise…
Health Partners Plans CHIP - Removal of Prior Authorization Requirements for PT/OT/ST
August 9, 2024
Thank you for being a valued participating provider. We are writing to inform you of an important update to the prior authorization requirements for our Health Partners Plans CHIP product. Effective October 1, 2024, Health Partners Plans CHIP will no…
Duplicate Claims Payment
August 8, 2024
Jefferson Health Plans recently received an unusually high volume of claims through our clearinghouse, SDS. These claims were submitted to SDS through another trading partner and included a high volume of duplicate claims. Certain claims were inadver…
Update to Prior Authorization Requirements - Sleep Studies
August 7, 2024
Thank you for being a valued participating provider. In an effort to reduce the administrative burden around prior authorization requests, effective October 1, 2024, Jefferson Health Plans will no longer require prior authorization for Sleep Studies…
Department of Human Services Mobile Clinic Survey
July 12, 2024
Health Partners Plans and Jefferson Health Plans, on behalf of the Pennsylvania Department of Human Services (DHS), would like to announce the launch of a survey DHS is conducting to gather more information on Mobile Health Clinics. If your organizat…
Newborn Stay Authorization Policy Update
June 28, 2024
Thank you for being a Jefferson Health Plans participating provider. Jefferson Health Plans is revising our authorization policy for obstetrical delivery and NICU nursery care. In July 2021, Jefferson Health Plans implemented an authorization policy …
Complete Required Annual D-SNP Model of Care Training by July 25
June 25, 2024
Thank you for being a participating Jefferson Health Plans provider. If your practice has at least one Jefferson Health Plans Medicare Advantage Special (D-SNP) member assigned to your practice, at least one person on your staff who is involved in th…
Quality Reports Calendar, KED, TRC, and Hypertension Best Practices Tip Sheets
June 21, 2024
Thank you for being a valued participating provider. Continuing with our commitment to ensure providers have the resources available to provide the highest quality of care to our members, the Quality Reports Calendar, Kidney Health Evaluation for Pa…
You're Invited: Improving Engagement Through Well Visit Events Webinar
June 12, 2024
Thank you for being a Jefferson Health Plans participating provider. We’d like to invite you to an upcoming webinar,Improving Engagement Through Well Visit Events, presented in partnership with CHOP. The webinar will be held on Tuesday, June 25 at 12…
Fluticasone HFA - Update to Preferred Drug List (PDL)
June 12, 2024
Thank you for your continuing efforts to improve the health outcomes of our members. On January 18, 2024, you were advised that GlaxoSmithKline (GSK) has discontinued manufacturing Flovent HFA and Diskus as of December 31, 2023, and were provided a l…
Provider Annual Orientation and Training Webinar Announcement for 2024
June 11, 2024
Thank you for being a valued participating provider. Jefferson Health Plans is hosting our Quarter 2 provider orientation and training webinar on June 19, 2024. Jefferson Health Plans requires all participating providers to demonstrate that they are…
Provider Manual 2024 Update
June 11, 2024
Thank you for being a valued participating provider. The Jefferson Health Plans’ Provider Manual, updated for 2024, has been finalized and is now available on our website at HPPlans.com/manual. As a reminder, the Provider Manual provides in-depth pl…
Prior Authorization Update - CHIP
May 29, 2024
Thank you for being a valued Jefferson Health Plans provider. We are writing to inform you of an important update to the prior authorization requirements for our Health Partners Plans CHIP (KidzPartners) product. Effective June 1, 2024, Jefferson He…
You're Invited: Care Coordination Support for You and Your Patients Webinar
May 21, 2024
We’d like to invite you to an upcoming webinar, Care Coordination Support for You and Your Patients. The webinar will be held on June 5 at 12:30 p.m. Our clinical programs can support your practice and your Health Partners Plans (Medicaid) and Health…
CAHPS & HOS Guidebook Updates
May 21, 2024
Jefferson Health Plans is focusing on improving patient satisfaction scores and elevating patients’ experience with their health plan and their providers. Jefferson Health Plans is committed to partnering with our network providers to elevate patient…
Summer 2024 Provider Check-up Newsletter is Now Available!
May 17, 2024
The Summer edition of the Jefferson Health Plans’ provider newsletter, Provider Check up, is now available on our website at hpplans.com/providernewsletter. In this issue, we provide information on the following topics: Change HealthCare Cyber Secur…
2024 Provider Access, Appointment and Telephone Availability Standards Survey is Now Available
April 29, 2024
Each year, Jefferson Health Plans surveys our network to determine if providers are meeting the Access and Appointment Standards and Telephone Availability Standards as set by the Department of Human Services (DHS) for Health Partners (Medicaid) and …
Bariatric Policy change
April 26, 2024
Thank you for being a valued participating provider. This letter is to inform you of an important change related to Elective Laparoscopic Sleeve Gastrectomy procedures for our Health Partners (Medicaid) and KidzPartners (CHIP) members. Effective 7/1…
Updates to APR DRG version
April 5, 2024
Thank you for being a participating provider with Jefferson Health Plans. This letter contains important information about the update to the current version of APR-DRG. In accordance with the Pennsylvania Department of Human Services (DHS) and per Je…
Self-Monitoring Blood Pressure Cuffs for Pregnant Members
April 4, 2024
According to the Center for Disease Control and Prevention (CDC), 1 in every 12 to 17 pregnancies among women ages 20 to 44 in the U.S. experience high blood pressure. In addition, CDC data shows that black women are two to three times more likely to…
Jefferson Health Plans and You: Enhancing Patient Experience Webinar
March 29, 2024
Jefferson Health Plans is hosting a webinar in collaboration with ProspHire, a healthcare focused management consulting firm, that will focus on the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey and best practices recommendat…
Quality Initiatives, Opportunities and Resources Webinar
March 22, 2024
Thank you for being a participating Jefferson Health Plans provider. You’re invited to participate in an upcoming webinar on Quality Initiatives, Opportunities and Resources on April 10, 2024. This webinar will offer insight from Jefferson Health Pla…
Smart Data Solutions Clearinghouse
March 15, 2024
Jefferson Health Plans has entered a partnership with Smart Data Solutions (SDS) Clearinghouse to accommodate Electronic Data Interchange (EDI) claim submissions for our two Payor IDs: Health Partners (Medicaid)/KidzPartners(CHIP)/Jefferson Health P…
Ancillary Provider Orientation and Training Announcement
March 5, 2024
Thank you for being a valued Jefferson Health Plans participating provider. Jefferson Health Plans is hosting our Ancillary Provider Orientation and Training webinar of 2024! The live webinar will be held on Wednesday, March 27, 2024, 12:30 to 1:30 p…
Provider Annual Orientation and Training Webinar Announcement
March 5, 2024
Jefferson Health Plans is hosting our first provider orientation and training webinar of the year on March 20, 2024. Jefferson Health Plans requires all participating providers to demonstrate that they are knowledgeable and trained on important topic…
Spring 2024 Provider Check up Newsletter is Now Available!
February 28, 2024
The Spring edition of the Jefferson Health Plans’ provider newsletter, Provider Check up, is now available on our website at HPPlans.com/ProviderNewsletter. In this issue, we provide information on the following topics: Jefferson Health Plans Produc…
Change Healthcare Cyber Security Incident: Authorization Process Update
February 23, 2024
As recently communicated, on February 21, 2024, Jefferson Health Plans was alerted by Change Healthcare about a cyber security incident they’ve experienced that is disrupting Change Healthcare’s ability to deliver services. We will continue to monito…
Change Healthcare Outage
February 22, 2024
On 2/21/24, Jefferson Health Plans was alerted by Change Healthcare about a network outage that is disrupting Change Healthcare’s ability to deliver services. This impacts providers who use Change Healthcare to send member eligibility verifications, …
Women’s Health Measures & Maternity Quality Care Plus (MQCP)
February 16, 2024
Thank you for being a participating Jefferson Health Plans provider. You’re invited to participate in an upcoming webinar on women’s healthcare topics on Wednesday, February 28, 2024. This webinar will review important details related to Jefferson He…
PCMH Specialist 7-Day Follow-up
February 15, 2024
As a requirement of the DHS Patient-Centered Medical Home (PCMH) program, patients admitted with an ambulatory sensitive condition must be seen by the primary care PCMH provider or specialist provider within seven days of discharge from the hospita…
2024 Medicare Member Wellness Rewards
February 5, 2024
Jefferson Health Plans will continue to offer Wellness Rewards, our Medicare rewards program, to all Medicare members in 2024. Wellness Rewards incentivizes Medicare members to complete specific health-related activities to earn rewards dollars on a …
2024 MQCP Manual
January 31, 2024
Thank you for being a Jefferson Health Plans participating provider and for your continued participation in our Maternity Quality Care Plus (MQCP) program. MQCP is designed to recognize and reward your practice’s performance in delivering high-qualit…
2024 Individuals and Families Resources
January 30, 2024
We are pleased to announce the live recording and presentation for the 2024 Individuals and Families OEP webinars held in October 2023 are now published to the provider page of our website, in addition to a self-led eLearning course. As a reminder, t…
Blood Pressure Cuff Guidelines
January 30, 2024
Effective immediately, we have simplified ordering a blood pressure cuff for our Medicare, Medicaid, CHIP* and Individual and Families (Exchange) lines of business. We encourage you to provide guidance to your patients on the proper use of the blood …
Jefferson Health Plans 2024 Medicare & Individuals and Families Webinar
January 29, 2024
You're invited to an upcoming Jefferson Health Plans’ Medicare/Individuals and Families (IFP) webinar. Our team will provide a review of the Medicare Advantage & IFP products and other guidelines, including: Medicare Advantage products for…
Pennsylvania Statewide Preferred Drug List - Asthma Inhaler Coverage
January 18, 2024
Thank you for your continuing efforts to improve the health outcomes of our members. This letter is to inform you that GlaxoSmithKline (GSK) has discontinued manufacturing Flovent HFA and Diskus as of December 31, 2023. For our Health Partners (Medic…
Maternal Transthoracic Echocardiograms
January 16, 2024
Thank you for being a valued participating provider. We are writing to inform you that effective February 1, 2024, prior authorization for Maternal Transthoracic Echocardiograms (CPT 93306) will no longer be required when accompanied by a pregnancy d…
Expansion of CHIP Program Offering
January 16, 2024
Thank you for being a valued provider. We are excited to announce that we are expanding KidzPartners, our Children’s Health Insurance Program (CHIP). KidzPartners is now offered in all 67 counties across the Commonwealth of Pennsylvania. Jefferson He…
Billing/Regulatory guidance for Hospice providers
January 5, 2024
Thank you for being a Jefferson Health Plans’ participating provider. In preparation for upcoming provider monitoring that Jefferson Health Plans’ Special Investigation Unit will performing, we would like to make you aware of some recent findings of …
Policy Notification: Professional Telehealth Services (Individual and Family Plans)
January 5, 2024
Thank you for being a Jefferson Health Plans participating provider. We are contacting you today to inform you of a new policy available in our Jefferson Health Plans Policy Bulletin Library. Effective January 1, 2024, Jefferson Health Plans will be …
Change Healthcare Cyber Security Incident FAQs (Updated 07/19/2024)
January 1, 0001
Member Eligibility, Billing & Payment Thank you for being a valued provider for members in one or more of our health plans: Health Partners Plans Medicaid, Health Partners Plans CHIP, Jefferson Health Plans Medicare Advantage, and/or Jefferson He…
