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Plan Info

Member Care FAQs

Do you want to know more about Health Partners Plans and how we work to assure high quality health services for our members?

What is Health Partners Plans’ Quality Management program?

HPP’s Quality Management (QM) program supports our commit to provide quality care and service to our members. It involves the entire company and includes: making sure information goes through our committees for review; reporting information on how we are doing to state and other agencies; and coordinating NCQ accreditation to measure plan quality.

What are its recent accomplishments and goals?

Our Quality Management program is designed to ensure that members receive safe and effective clinical care that is timely and patient centered. Throughout the year, Health Partners Plans (HPP) monitors the delivery of health care to our members and annually evaluates the program to determine if goals were met and define goals for the year ahead. Visit our Quality Management's goals page to review a full list of recent accomplishments and goals?

How does Health Partners Plans help assure access to appropriate health services?

Our Utilization Management guidelines can be found in Chapter 8 of HPP’s Provider Manual.

How does Health Partners Plans evaluate coverage of new medical technology?

Information on how HPP makes decisions about coverage of new medical technology can be found in Chapter 7 of HPP’s Provider Manual.

What can I do if Health Partners Plans denies a requested item or service?

More information about denials can be found in Chapter 7 of HPP’s Provider Manual.

How can I discuss a decision with a Health Partners Plans medical director?

Health Partners Plans medical directors are available to discuss utilization review decisions with peers by calling 215-967-4570.

What are Health Partners Plans’ access and appointment standards for participating providers?

Our current access and appointment standards for participating providers can be found in Chapter 10 of HPP’s Provider Manual.

Where can I find information about member satisfaction with Health Partners?

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. 

What rights and responsibilities do Health Partners Plans members have?

Members have the right to know about their Rights and Responsibilities. Exercising these rights will not negatively affect the way they are treated by Health Partners Plans, its participating providers or other State agencies. Our members also have the right to make healthcare decisions without feeling as though Health Partners Plans is restraining, isolating, influencing, bullying, punishing or retaliating against them. Health Partners Plans and its network of providers do not discriminate against members based on race, sex, religion, national origin, disability, age, sexual orientation, gender identity, or any other basis prohibited by law. A full description of Member Rights and Responsibilities can be found in Chapter 14 of HPP’s Provider Manual.

How can I get information about providers that participate with HPP?

Our online provider directory offers the most current information available about our network of primary care physicians, specialists, hospitals, designated radiology and lab facilities, DME providers and much more. Please use this directory when providing referrals/scripts for our members. A Spanish version of this tool is also available.

The Provider ManualClinical Care Guidelines and other information on our website are updated as necessary.

For More Information

HPP is ready to answer any additional questions you may have about coverage, claims, and how to work with our health plans. Please call the Provider Services Helpline at 1-888-991-9023 (Monday to Friday, 9 a.m. to 5:30 p.m.), or contact your Network Account Manager.