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Providers News: 2016

New Opioid Use Edits Effective 1/1/2017

Effective January 1, 2017, Health Partners Plans (HPP) will implement new edits on opioid use by our Medicare members, to comply with new regulations from the Centers for Medicare and Medicaid Services (CMS).   Starting January 1, an HPP Medicare m…

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Get TiPS on Treating Psychiatric Mental Health

Primary care physicians can receive support to help meet the mental health needs of children and youth enrolled in Health Partners (Medicaid) through the Telephonic Psychiatric Services (TiPS). This Pennsylvania HealthChoices program provides real-ti…

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2016 Pediatric Dental Symposium

The Pediatric Dental Symposium — previously scheduled for November 2 — is postponed until Wednesday, November 30 due to potential complications resulting from the SEPTA strike.   Dental care is an essential element of primary care for children. To …

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Join us for Buprenorphine Summit on September 20

As part of our effort to address the ongoing opioid epidemic affecting our communities, providers in the Health Partners Plans network are invited to a Buprenorphine Summit, on Tuesday, September 20, from 9:00 a.m. - 12:00 p.m. Health Partners Plans…

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Healthy Teeth Healthy Children Webinar (Recap)

On August 26, 2016, Health Partners Plans hosted a webinar with the American Academy of Pediatrics to offer an overview of the Healthy Teeth Healthy Children program, which helps fight tooth decay—a common chronic issue among our youngest members. P…

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Announcing Our Provider Orientation and Training Webinar

All PCPs and specialists are invited to participate in the upcoming Health Partners Plans Provider Orientation and Training Webinar. Health Partners Plans Provider Orientation and Training WebinarPresenter: Lisa MalloryWednesday, November 912:30 – 1…

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Webinar: Healthy Teeth Healthy Children Training Program

Tooth decay remains a common chronic issue among our youngest members despite early detection efforts, increased coverage and access to preventive services such as fluoride varnishes. To help combat this problem, the Pennsylvania chapter of the Amer…

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Temporary holiday change to our claim payment cycles

Due to the upcoming holiday, Health Partners Plans will implement a temporary one-day change in the claim cycle this week. The claim cycle for claims processed through Monday, May 23 will be run one day earlier, on Wednesday, May 25. As a result, wh…

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Medicare prior authorization peer-to-peer process

Health Partners Plans (HPP) follows CMS regulations for the HPP peer-to-peer process for prior authorization requests. This is a reminder that HPP will follow the Medicare prior authorization process for determinations and member appeal rights. This …

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Outpatient prior authorization changes postponed

The previously announced implementation of new prior authorization requirements for certain outpatient services is being postponed. We had previously communicated that these services would require prior authorization from Health Partners Plans or evi…

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Training for Providers: Member Rights and Responsibilities

As part of our Pennsylvania HealthChoices Agreement, Health Partners Plans (HPP) is required to educate our provider network about our member rights and responsibilities. Understanding our Member Rights and Responsibilities policy can help  your pra…

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Provider Data Validation – Quarterly Outreach Requirement

The Centers for Medicare and Medicaid Services recently implemented a new regulation effective January 1, 2016 that requires Medicare Advantage plans to routinely validate provider data. The regulation will ensure that our members can access health c…

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PA Access Cards

Medicaid Fee for Service (FFS) is the payer for Medicaid-participating members who have enrolled for benefits through Health Partners Plans, but have not yet become effective. Please be aware that providers are required to accept the member’s Pennsyl…

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Recent Change to Medical Home Health / Hospice Codes

Per the Centers for Medicare and Medicaid Services’ (CMS) October 15, 2015, “MLN Matters” news flash #MM9369, HCPCS G-Code G0154 was split into 2 separate G-Codes: G0299 and G0300 on January 1, 2016. G0154 (Direct skilled nursing services of licen…

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Revalidation of Enrollment Information

In accordance with the Affordable Care Act, the Pennsylvania Department of Human Services (DHS) is required to revalidate all providers at least every five years. As a result, DHS is requesting that all providers who enrolledon or before March 25, 20…

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