Provider News: 2019
Updated Medical Necessity Policy: Whole Genome Sequencing/Whole Exome Sequencing to be implemented 12/1/2019
November 1, 2019
Effective December 1, 2019, HPP will be implementing an updated medical necessity policy: MN.011.C Whole Genome Sequencing (WGS) and Whole Exome Sequencing (WES). In the previous version of the policy (B) WES is considered to be Experimental/Investi…
New Reimbursement Policy: Professional Telehealth Services to be implemented 12/1/2019
November 1, 2019
Effective December 1, 2019, HPP will be implementing a new reimbursement policy: RB.012.A Professional Telehealth Services. Telehealth is the use of electronic information and communications technologies by a health care provider to deliver services…
Register Now: Tobacco, Nicotine and Vaping: Prevention and Treatment Webinar (11/13)
October 31, 2019
Health Partners Plans will be hosting a one-hour webinar regarding tobacco, nicotine and vaping on Wednesday, November 13 at 12:30 p.m. Led by Sean McCormick, PhD, MS, CTT-M, from the Health Promotion Council, the webinar will cover smoking, vaping a…
New Medical Necessity Policy: Peroral Endoscopic Myotomy (POEM) to be implemented 11/1/2019
October 2, 2019
Effective November 1, 2019, HPP will be implementing a new medical necessity policy: MN.020.A Peroral Endoscopic Myotomy (POEM). Peroral endoscopic myotomy (POEM) is a surgical technique used in the treatment of esophageal achalasia (EA)—an uncommon…
Health Partners Plans to start Synagis Prior Authorizations Process on October 15
September 25, 2019
Health Partners Plans (HPP) will start the annual Synagis Prior Authorization process on October 15, 2019, two weeks before the respiratory syncytial virus (RSV) season begins. Synagis (palivizumab) is a monoclonal antibody indicated for the preventi…
HealthRules Payor—New Claims Platform Implementation Delayed for Medicaid and Medicare
September 23, 2019
Health Partners Plans recently announced that we would be adopting a new claims processing platform called HealthRules Payor (HRP). This change is intended to improve our claims adjudication processes and ensure our claims processing system is curren…
Register Now: Maternity Authorizations and Claim Submissions Webinar (9/26)
September 16, 2019
Health Partners Plans will be hosting a one-hour webinar regarding maternity authorizations and claims submissions on Thursday, September 26. We will identify issues that delay authorization approvals and claim payments and review best practices to h…
2019 Wellness Rewards Program available for Health Partners (Medicaid) and KidzPartners members
September 16, 2019
As a reminder, in 2018 HPP introduced a member incentive program called HPP Rewards for our Health Partners (Medicaid) members. We are excited to announce that we will now extend this popular incentive program to our KidzPartners (CHIP) members. Bet…
CCMP Updates Scheduled for September 16, 2019
September 12, 2019
Please be aware that effective September 16, 2019, an improved Chronic Care Management Program (CCMP) tool is being reintroduced* on our NaviNet provider portal. The updated CCMP tool features a number of improvements that enhance your experience, i…
Oral Health and Preventive Care in Your Medical Office—Revenue Opportunities for Fluoride Varnish Certification
September 3, 2019
Providers have a valuable opportunity to participate in a one-hour oral health training webinar that will provide state certification, one CME/CEU credit and increased revenue opportunities for your practice. >> Register for Webinar ORAL HEA…
Change regarding HCPCS Code T1015
September 3, 2019
Effective October 1, 2019, HPP will no longer reimburse certified nutritionists and dieticians for claims submitted with Healthcare Common Procedure Coding System (HCPCS) code T1015 (Clinic visit/encounter, all-inclusive). Going forward, we will req…
Reminder: Provider Orientation and Training Webinar to be held Wednesday, August 21
August 20, 2019
As a reminder, Health Partners Plans will host our third-quarter 2019 Provider Orientation and Training webinar on Wednesday, August 21, 2019. HPP requires all participating providers to demonstrate that they are knowledgeable and trained on importan…
Medical Records Requirement (BPI)
August 12, 2019
As a reminder, the Pennsylvania Department of Human Services’ Bureau of Program Integrity (BPI) is responsible for retrospective monitoring and the review of services for compliance with Medical Assistance (MA) regulations. When BPI, or any regulato…
Talk to Patients about the Importance of Preventive Screenings
August 9, 2019
Despite evidence supporting the effectiveness of colorectal cancer screening and the variety of test options available, screenings for colorectal cancer remain lower than those for breast and cervical cancers.* However, screenings may increase when p…
HealthRules Payor—New Claims Platform Coming October 1
August 1, 2019
Health Partners Plans will soon moving to a new claims processing platform: HealthRules Payor (HRP). HRP will begin handling all claims processing for our Medicaid and CHIP product lines effective October 1, 2019, and for our Medicare product line b…
Elimination of Lump-sum Purchase Option for Power Wheelchairs and Accessories over $500
July 31, 2019
Please be aware of this important change to HPP’s reimbursement policy regarding standard power wheelchairs and related accessories over $500. Effective September 1, 2019, in accordance with provisions of the Affordable Care Act and guidelines by t…
Breast Pump Purchases and Rentals
July 19, 2019
Health Partners Plans is committed to giving our members the support they need to breastfeed successfully. As part of this effort, we want to remind providers that HPP members are eligible to receive an electric breast pump after delivery and withou…
Register Now: Provider Orientation and Training Webinar Registration Scheduled for August 21
July 18, 2019
HPP will host our third-quarter 2019 Provider Orientation and Training webinar on Wednesday, August 21, 2019. HPP requires all participating providers to demonstrate that they are knowledgeable and trained on important topics and participate in at le…
Reminder—2019 HPP Benefits Available
July 10, 2019
As a reminder, our Health Partners (Medicaid), KidzPartners (CHIP) and Health Partners Medicare member benefits are available online. These documents list the benefits available to HPP members—as well as prior authorization, cost sharing and/or benef…
HP Connect Provider Portal Enhancements
July 5, 2019
Starting on July 8, we will begin the rollout of important changes to our HP Connect provider portal. These changes will allow you to efficiently provide all appropriate clinical information to support your authorization requests. These changes are i…
Hospital Readmissions: Peer-to-Peer Reviews
June 21, 2019
As a reminder, providers have the opportunity to request a peer-to-peer review to discuss the medical director’s determination related to a combined readmission. For help with initiating the peer-to-peer review process, please contact our Physician …
Medicare Diabetes Prevention Program (MDPP) Sites Expanded
June 20, 2019
Health Partners Plans is excited to announce that we've contracted with the YMCA of Delaware in Wilmington to offer our new Medicare Diabetes Prevention Program (MDPP) benefit. We wanted to be sure that you knew this site is now available to your pat…
New Diabetes Incentive for Health Partners (Medicaid) Members
June 19, 2019
We’re excited to tell you about an important new member incentive designed to positively impact the health of your Health Partners (Medicaid) patients. As you know, diabetes can be prevented or delayed in prediabetic patients. Participation in a Dia…
The Opioid Epidemic
June 18, 2019
Opioid addiction affects millions of Americans and their families across all races and income levels. As our members’ trusted health care partner, we want to help them get support and recovery services in a compassionate environment. We’ve develop…
Immunizations for Health Partners (Medicaid) and KidzPartners Members
June 13, 2019
You may be answering more questions about vaccines because of news reports about infectious disease outbreaks. As a physician, you know that immunization is crucial for limiting and preventing these dangerous outbreaks. Partnering with Health Partner…
Best Practices for Your Youngest Patients
June 12, 2019
During a busy day caring for patients or your office needs, it’s not always easy to find time to contact families and remind them to schedule their newborn checkups or other screenings. Scheduling these visits can not only help improve health outcome…
Our Spring 2019 Provider Newsletter is Now Available
June 10, 2019
The Spring edition of the Health Partners Plans provider newsletter, Providers in Focus, is now available on our website. Learn more about 2019 provider education & training opportunities, our improved Medicare Wellness Rewards program, disease/…
Medicaid Specialty Pharmacy Update
June 4, 2019
Effective June 6, 2019, Acro Pharmaceutical Services will close and no longer be available to your Health Partners Plans patients. Acro Pharmaceutical Services has confidentially transmitted its prescription files to CVS Specialty Pharmacy Services, …
Pennsylvania Perinatal Quality Collaborative (PA PQC)
June 3, 2019
We would like to bring to your attention the recent launch of the Pennsylvania Perinatal Quality Collaborative (PA PQC) and provide you with information to help you take advantage of this great new resource. Participation of HPP-contracted providers …
Access, Appointment & Availability Standards
May 31, 2019
Timely access to quality health care is extremely important for our members. As you should be aware, it is a regulatory requirement that all HPP-participating PCPs, specialists and Ob/Gyns must meet clearly defined access, appointment and availabilit…
Proper Billing for Combined Sick Visits and Well-Child Visits (Modifier 25)
May 29, 2019
One of Health Partners Plans’ primary goals is to ensure our youngest members receive the preventive care they need. That’s why we often stress that you should complete a well-child visit when a child has come in for a sick visit. You should to this …
Reportable Conditions – PA-NEDSS
May 28, 2019
As a reminder, all hospitals, laboratories, providers and public health staff are required by law to report certain conditions to the Commonwealth of Pennsylvania’s Department of Health (PA DOH). This requirement is outlined in Chapter 27 (Communica…
Certifications for Small Businesses (SBs) and Small Diverse Businesses (SDBs)
May 23, 2019
HPP works with Pennsylvania-certified Small Businesses (SBs) and Small Diverse Businesses (SDBs). We feel so strongly about diverse business partnerships that we have exceeded our original commitment, working with SBs and SDBs at a level of more than…
Shift Care Staffing and Reporting – Upcoming Webinars
May 22, 2019
The Pennsylvania Department of Human Services (DHS) requires HPP to provide accurate reporting of missed shifts for all authorized shift care services. To meet the DHS regulatory requirement, HPP requires all agencies authorized for shift care servic…
Tips for Boosting CAHPS Scores... and How It Can Help Your Practice
May 20, 2019
"Getting needed care" and "getting care quickly" are important components of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey—a member survey that occurs annually from March through June. Some of your Health Partners Plans …
Wellness Rewards: Our Improved Medicare Incentive Program
May 9, 2019
In 2018, Health Partners Medicare introduced a member incentive program, HPP Rewards, for our Health Partners Medicare members. We are excited to announce that we will continue to offer an incentive program to all of our Medicare members in 2019. Th…
Now Available for Download: Recent HPP Webinars
May 3, 2019
As part of our ongoing effort to ensure that provider offices and staff are knowledgeable and trained on topical issues, we have recently made available copies of our 2018 and 2019 HPP webinars. Webinar presentations are accessible through the Provi…
Provider Webinar: Care Coordination Support and Your Patients, June 6
May 2, 2019
HPP’s clinical programs work with your treatment plan to support your practice and your Health Partners (Medicaid) and KidzPartners (CHIP) patients. These programs help your Quality Care Plus (QCP) reimbursement and overall quality of care you provid…
HEDIS Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents (WCC)
April 23, 2019
The HEDIS WCC measure was developed to address the childhood obesity epidemic for our Health Partners (Medicaid) and KidzPartners (CHIP) members. As the patient’s PCP or OB-GYN, you play a key role in guiding children and adolescents toward healthy b…
Provider Orientation and Training Webinar: Wednesday, May 15, 2019
April 18, 2019
HPP is hosting the second of four 2019 provider orientation and training webinars on May 15, 2019. As a reminder, HPP requires all participating providers to demonstrate that they are knowledgeable and trained on important topics annually. Participat…
Congestive Heart Failure Self-Management for Health Partners Medicare Patients
April 15, 2019
Did you know that Health Partners Plans (HPP) offers home monitoring tools to help members self-manage congestive heart failure (CHF)? CHF is one of the most common causes of Emergency Department visits and death. As a patient’s trusted primary care…
2019 Maternity Quality Care Plus Program
April 10, 2019
Our Maternity Quality Care Plus (MQCP) program is designed to recognize and reward your practice’s performance throughout the year. Based on a recent assessment of the MQCP program to ensure a positive impact on both pregnant members and in-network …
Webinar Invitation: Continuity of care, provider communication, and optimal reimbursement begin in a patient’s chart
April 10, 2019
Health Partners Plans will be hosting a new webinar intended to help offices streamline operations to help ensure continued high quality care to our members. The adoption of better medical record documentation practices and the avoidance of common c…
Annual D-SNP Model of Care Training – Required
April 8, 2019
Providers with at least one Health Partners Medicare Special (HMO SNP) member assigned to your panel should receive a letter explaining that one staff member involved in the care of special needs plan members must complete our annual D-SNP Model of C…
Insulin Glargine Formulary Change (Basaglar to replace Lantus)
March 22, 2019
Health Partners Plans is committed to supporting efforts to improve the health of our diabetic members through various treatment regimens, including the efficient management of diabetic medications. To help maintain high quality care while reducing h…
Cut Through the Confusion: Understanding Health Partners Medicare and Community HealthChoices (CHC)
March 13, 2019
Health Partners Plans (HPP) is here to help you understand more about Health Partners Medicare and Community HealthChoices. Learn more about Pennsylvania’s mandatory, managed Medicaid program by attending a provider webinar, "Cut Through the Confusio…
Pay-for-Performance (P4P) Provider Initiatives Webinar Series Begins March 27, 2019
March 11, 2019
Health Partners Plans (HPP) is here to help you navigate the clinical quality measures related to provider performance and better patient health outcomes through a series of provider webinars starting March 27, 2019. The series offers insight from H…
Changes to Prenatal Billing Requirements
March 8, 2019
As a reminder, the passage of the Bipartisan Budget Act of 2018, signed by President Trump in February of 2018, resulted in an amendment to section 1902(a)(25)(E) of the Act that changes how we must process Health Partners (Medicaid) and KidzPartners…
DHS Enrollment Required by July 1, 2019
February 18, 2019
The Pennsylvania Department of Human Services (DHS) released a Medical Assistance Bulletin (#99-18-11, Service Location Enrollment Deadline) at the end of last year and a CHIP Transmittal early this year that requires all providers who render service…
2019 Quality Care Plus Program
February 14, 2019
Our Quality Care Plus (QCP) program is designed to recognize and reward your practice’s performance in delivering quality services throughout the year. Each year, we assess the program to ensure a positive impact on both our members and our provider…
Provider Orientation and Training Webinar: Wednesday, February 20, 2019
February 11, 2019
HPP is hosting the first of four 2019 provider orientation and training webinars on Wednesday, February 20, 2019. To register, visit our Provider Webinars web page and click "Register" next to the February 20 listing. You will receive an email confi…
Routine Foot Care for Health Partners (Medicaid) Adult Members
February 1, 2019
This is a notification regarding upcoming changes regarding coverage of routine foot care. As a reminder, routine foot care is not a covered benefit for Health Partners (Medicaid) members. Effective April 1, 2019, routine foot care procedures will b…
Reminder: Pennsylvania License Requirements
January 25, 2019
Health Partners Plans credentialing standards require all practitioners to maintain a current and unrestricted Pennsylvania professional license. We urge you to work with the state to ensure that your professional licenses are renewed in a timely ma…