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Provider Manual Update Notification

Please be aware that we have made a series of updates to our HPP Provider Manual, effective July 1, 2018.

Below is a short summary of these updates.

Chapter 10: Employee Screening Standards

Based on input from the Department of Human Services (DHS), we added language clarifying that participating provider offices agree, under their contract with HPP, that all employees within the provider office, prior to being hired and monthly thereafter, must be screened using MediCheck, the U.S. Department of Health and Human Services-Office of Inspector General’s (HHS-OIG) List of Excluded Individuals and Entities (LEIE), the Social Security Administration’s Death Master File (SSADMF), the Excluded Parties List System (EPLS) on System for Award Management (SAM) databases, and the National Plan and the ProviderEnumeration System (upon enrollment and re-enrollment).

It is the responsibility of the employer to perform the sanction screenings on all employees within the Fraud, Waste & Abuse safeguards of participation in the Federal and State government programs.

Chapter 12: Complaints, Grievances & Appeals

Due to federal regulatory changes, DHS has made changes to the Medicaid member complaint and grievance process, effective July 1, 2018. These changes include:

  • Members must exhaust HPP’s Complaint or Grievance processes before
    they can request a Fair Hearing.
  • The Grievance process now has one level of review. All grievances have the same appeal rights.
  • Members, or an authorized representative, may now submit requests for Expedited Complaint or Grievance review to HPP via email at quickCGA@hpplans.com. If a member does not like the outcome of the complaint review, they may file a Fair Hearing and/or External Review.
  • Member complaints are split into two categories:
      1. Complaints that result from a member receiving a decision or denial notice from HPP, and
      2. Complaints that are not the result of a decision notice, and include general dissatisfaction with quality of care or services, or interpersonal relationships with providers and their staff. In both cases, if the member does not like the outcome of the complaint review, they may file a second level complaint review.

 Chapter 14: Member Rights & Responsibilities

At the request of DHS, we have updated documentation regarding our member’s rights and responsibilities, which we reproduce for providers in Chapter 14.

 Additional Updates

The Case Management phone number listed on page 1.13 has been updated. The new phone number is 215-845-4797.

We also modified language regarding Filing Period Exceptions on page 11.13. Non-par Medicare providers must submit claims within 395 days of the date of service (instead of 27 months as previously listed).

 General Reminders

As a reminder, the 2018 HPP Provider Manual reflects current policies and procedures for our Medicaid (Health Partners), CHIP (KidzPartners), and Medicare (Health Partners Medicare) plans. It is considered an extension of your participating provider agreement.

Chapters Include:

  • 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: Utilization Management
  • Chapter 8: Quality Management
  • Chapter 9: Healthier YOU
  • Chapter 10: Provider Practice
  • Chapter 11: Provider Billing & Reimbursement
  • Chapter 12: Complaints, Grievances,
    and Appeals
  • Chapter 13: Medicare Compliance Requirements
  • Chapter 14: Member Rights & Responsibilities
  • Chapter 15: Appendix