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Providers

Provider Manual

The provider manual reflects current policies, procedures and applicable changes to all our product lines and is considered an extension of your participating provider agreement.

View Manual
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Provider Manual Updates

Per your contract, communications (e.g., billing guides, letters, newsletters and bulletins) distributed via mail or posted on our website may be considered an extension of the provider manual. If 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).

Frequently Asked Questions

The PA Department of Human Services (DHS) gathers satisfaction measures by plan, using the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey, and Medicaid Health Care Effectiveness Data and Information Set (HEDIS®) and Pennsylvania Performance Measures reporting. The Consumer Guides contain information on member satisfaction.

Our online provider directory offers the most current information available about our network of primary care physicians, specialists, hospitals, designated radiology and lab facilities, durable medical equipment (DME) providers and much more. Please use this directory when providing referrals or prescriptions for our members. To request a Spanish version of this tool, please contact the provider services helpline at 1-888-991-9023.