The Jefferson Health Plans Provider Manual reflects current policies, procedures and applicable changes to our Medicaid (Health Partners), CHIP (KidzPartners), and Health Partners Medicare product lines, and is considered an extension of your participating provider agreement.

We are currently finalizing an updated version for the current calendar year.

Download the entire HPP Provider Manual:

• Provider Manual

Go directly to a specific chapter:

• Chapter 1: Introduction
• Chapter 2: Cultural Competency & Nondiscrimination
• Chapter 3: Member Eligibility & Enrollment
• Chapter 4: Health Partners (Medicaid) Benefits
• Chapter 5: Health Partners Medicare Benefits
• Chapter 6: KidzPartners Benefits
• Chapter 7: Jefferson Health Plans Individual and Family Plan Summary of Benefits
• Chapter 8: Utilization Management
• Chapter 9: Quality Management
• Chapter 10: Clinical Programs
• Chapter 11: Provider Practice Standards & Guidelines
• Chapter 12: Provider Billing & Reimbursement
• Chapter 13: Complaints, Grievances, and Appeals
• Chapter 14: Medicare Compliance Requirements
  
  • HPP Code of Business Conduct (COBC): The COBC outlines the principles, values, and expectations that HPP considers significant and believes are fundamental to our success as an organization.
  • HPP Compliance Program Policy: This document outlines the key components of our HPP Compliance program, including all elements required of HPP by CMS.

• Chapter 15: Member Rights & Responsibilities
• Chapter 16: Appendix

Provider Manual Updates Library

Per your contract, communications (e.g., billing guides, letters, newsletters and bulletins) distributed via mail or posted via our HPP website may be considered an extension of the Provider Manual. In the event that we release a communication that includes language that supersedes language found in the Provider Manual, we will clarify this in the communication and identify the affected chapter(s) and page number(s).

• Provider Manual Quick Reference Guide

Your feedback is important to us

If you have any recommendations for the manual or its online presentation, please share them by calling our Provider Services Helpline at 1-888-991-9023.