Provider Quick Reference Guide
Provider Portal

HealthPartnersPlans.com/ProviderPortal

Services available through our portal include:

• Elegibility and benefit verification

• Claim status inquiry

• Claims reconsiderations

• Authorization requests

• Access to reports/documents/provider communications

Provider Services Helpline:

1-888-991-9023
(Mon – Fri, 9:00 a.m. – 5:00 p.m.)

See below for plan ID cards and claims submission information.

Pharmacy
Pharmacy Department:

1-866-841-7659

To fax prior authorization requests, please use the numbers below:

• Medicare Advantage: 1-866-371-3239
• Individual and Family Plans: 1-833-605-4407

Recipient Restriction Program:

Call 215-991-4094 for member information.

Credentialing
Credentialing Status, Correspondence & Enrollment:

Credentialing@jeffersonhealthplans.com
Fax: 215-967-4473

Credentialed Provider Linkages, Terminations and Changes:

DataValidation@jeffersonhealthplans.com
Fax: 267-515-6650

Hospital/Facility Based and Physical/ Occupational/Speech Therapy Linkages, Terminations & Changes:

ProviderData@jeffersonhealthplans.com
Fax: 215-967-9274

Claims Submissions/ID Cards

Please see the table below for all claims submission information. Note: Health Partners Plans/Jefferson Health Plans recommends electronic claims submissions.

EDI (Electronic Data Interchange) Support:

EDI@jeffersonhealthplans.com

Claims Status, Inquiries and Reconsiderations:

Review, inquire and appeal claims via our provider portal.

Medical Management (Utilization/Prior Authorization)

1-866-500-4571

• Ancillary Services (DME, home health care): prompts 2, 2
• Inpatient/Outpatient Services (prior authorizations): prompts 2, 3
• Non-Par Service Requests: prompts 2, 4
• Physician Peer-to-Peer Hotline: prompts 2, 1

Inpatient Appeals:

Appeals@jeffersonhealthplans.com

Skilled Nursing Facilities and Rehabilitation:

• Medicare: 215-991-4395
• Medicaid: 267-385-3825
• Fax: 215-991-4125

Clinical Care Management

Refer patients by contacting Clinical Care Management at 1-215-548-4797 or emailing clinicalconnections@jeffersonhealthplans.com.

Online Resources

www.HealthPartnersPlans.com/home/providers/

Find more detailed information about:

• Provider Manual
• Prior Authorization guidelines and forms
• Claims and Billing information
• News and updates
• Trainings and webinars
• Provider Directory
• Formularies
• Clinical Resources

Member Websites:

Medicaid and CHIP:
www.HealthPartnersPlans.com

Medicare Advantage and Individual and Family Plans:
www.JeffersonHealthPlans.com

Compliance, Privacy, and Fraud, Waste and Abuse

To report an actual or suspected Compliance, Privacy, or Fraud, Waste or Abuse incident:

Call 1-866-477-4848. You may remain anonymous.

Email one of the following email inboxes:

• Compliance@jeffersonhealthplans.com
• siutips@jeffersonhealthplans.com
• specialinvestigationsunit@jeffersonhealthplans.com

Vendor Information

Avēsis (Dental):
1-800-952-6674
www.myavesis.com/providers

Davis Vision:
1-800-773-2847
www.davisvision.com/eye-care-professionals

ECHO Health (Electronic Funds Transfer and Remittance Advice):
1-888-834-3511
www.echohealthinc.com

eviCore (Radiology, Cardiology, MSK (Joint, Spine, Pain) and Sleep):
1-888-693-3211
http://www.evicore.com/provider

eviCore (Radiation Oncology, Medical Oncology, Therapies (PT, OT, Speech) and Chiropractic):
1-888-444-6178

Behavioral Health Services:

Health Partners Plans Medicaid:
https://www.dhs.pa.gov/HealthChoices/HC-Services/Pages/BehavioralHealth-MCOs.aspx

Health Partners Plans CHIP; Jefferson Health Plans Medicare Advantage, Individual and Family Plans:
Optum Behavioral Health
1-877-614-0484, (Monday – Friday, 8 a.m. to 8 p.m. ET)
Optum Behavioral Health Resource Guide

Lab Services:

Quest Diagnostics: 1-866-697-8378
LabCorp: 1-800-745-0233
HNL Lab Medicine: 1-877-402-4221

Quality Management and Audits
Quality Management Department:

1-855-218-2314

STARS/HEDIS Initiatives:

Hedis_records@jeffersonhealthplans.com
Fax: 215-967-9230

Care Gaps:

caregap_records@jeffersonhealthplans.com
Fax: 215-967-9230

Audits:

audit@jeffersonhealthplans.com
Fax: 215-967-4477

QOC/Complaints:

quality@jeffersonhealthplans.com
Fax: 267-515-6648

Health Partners Plans Medicaid

Member ID is 9 characters, starting with numeric digits

Payor ID: #80142

Paper Claims Submissions:

Jefferson Health Plans
PO Box 21228
Tampa, FL 33622

Health Partners Plans CHIP

Member ID is 10 characters, starting with either a "3" or "9"

Payor ID: #80142

Paper Claims Submissions:

Jefferson Health Plans
PO Box 21228
Tampa, FL 33622

Jefferson Health Plans Medicare - Pennsylvania (HMO/DSNP and PPO)

Member ID is 7 characters, starting with "5"; PPO or HMO is identified on the ID card

  • HMO/DSNP Payor ID: #80142

  • PPO Payor ID: #RP099

HMO Paper Claims Submissions:

Jefferson Health Plans
PO Box 21228
Tampa, FL 33622

PPO Paper Claims Submissions:

Jefferson Health Plans
PO Box 21247
Tampa, FL 33622

Jefferson Health Plans Medicare - New Jersey (HMO and PPO)

Member ID is 7 characters, starting with a "5"; PPO or HMO is identified on the ID card

  • HMO Payor ID: #80142

  • PPO Payor ID: #NJ099

HMO Paper Claims Submissions:

Jefferson Health Plans
PO Box 21228
Tampa, FL 33622

PPO Paper Claims Submissions:

Jefferson Health Plans
PO Box 21367
Tampa, FL 33622

Health Partners Individual and Family Plans

Member ID is 12 characters, starting with "J"

Payor ID: #80142

Paper Claims Submissions:

Jefferson Health Plans
PO Box 21228
Tampa, FL 33622

Health Partners Plans, Inc. (HPP), uses Jefferson Health Plans as the marketing name for some of its lines of business. Current lines of business are: Jefferson Health Plans Individual and Family Plans, Jefferson Health Plans Medicare Advantage, Health Partners Plans Medicaid, and Health Partners Plans CHIP. All communications will specify the impacted line of business within the content of the message.