January 9, 2018
Updated 2018 HPP Provider Manual Now Available (Medicare Specialist Referrals)
Due to recent changes regarding Medicare specialist referral requirements, we have updated our 2018 HPP Provider Manual. This updated version can be found on our Provider Manual web page.
Going forward, we will notify you whenever significant changes have been made to the Provider Manual. As a reminder, our Provider Manual reflects current policies and procedures for our Medicaid (Health Partners), CHIP (KidzPartners), and Medicare (Health Partners Medicare) plans, and is considered an extension of your participating provider agreement.
Medicare Specialist Referral Requirements
As communicated previously, effective January 1, 2018, Health Partners Plans requires specialist referrals for most* Health Partners Medicare members. For more information, refer to our Specialist Referral Requirement (Medicare) FAQ.
We’re also hosting a final provider webinar on this new requirement on Thursday, January 11. During our third webinar on this topic, we’ll provide an overview of the requirement, instructions on completing referrals using the HP Connect portal, and answer any of your questions. Register now by visiting our Provider Webinars web page.
In addition to updating language regarding this new Medicare referral requirement, we have also made several adjustments to our Medicare benefits. These changes can be found in Chapter 5: Health Partners Medicare Summary of Benefits.
* This new referral requirement includes all Health Partners Medicare Special (HMO SNP) members as well as Health Partners Medicare Prime, Health Partners Medicare Value and Health Partners Medicare Basic members who reside in Philadelphia, Bucks, Chester, Delaware and Montgomery counties.
Specialist referrals are not be required, however, for those members enrolled in our Health Partners Medicare Prime and Health Partners Medicare Value plans who live in Lancaster, Lehigh and Northampton counties.