Provider News: 2021
COVID-19 Update: Authorization Process Changes – Update to Prior Communication
December 20, 2021
Health Partners Plans (HPP) is always looking for ways to partner with you to support the care of our members. We are providing updates since our last communication dated June 1, 2021. The below applies to all lines of business managed by HPP and …
Diabetic Retinopathy Screening and Fundus Photography Notification
December 8, 2021
Health Partners Plans (HPP) would like to inform you of upcoming changes to our HPP Policy Bulletin Library. Effective January 1, 2022, HPP will be implementing a new claim payment policy: RB.023.A Diabetic Retinopathy Screening and Fundus Photograph…
Billing Update for 2022 COVID-19 Vaccine and Monoclonal Antibodies
December 1, 2021
The Centers for Medicare & Medicaid Services (CMS) has instructed Health Partners Plans that effective for dates of service on and after January 1, 2022, COVID-19 vaccines and monoclonal antibodies provided to patients enrolled in a Medicare Adva…
New PO Box for Paper Claims Submissions
December 1, 2021
Although Health Partners Plans (HPP) prefers that providers submit claims electronically using our Payer ID #80142, we recognize some providers may need to submit paper claims. Effective 1/1/2022, HPP will be changing our address for all paper claim …
Update to Our Acupuncture Benefit for Health Partners (Medicaid) Members
November 22, 2021
Every year, Health Partners Plans (HPP) reviews the benefits we offer to our members. We want to make sure our benefits are helping our members live a happy, healthy life. HPP may add new benefits or stop offering benefits based on what our members t…
The Winter Issue of Provider Check Up is Available Now!
November 16, 2021
The Winter edition of the Health Partners Plans provider newsletter, Provider Check Up, is now available on our website. Learn more about provider services and support, member benefits, upcoming education and training opportunities, disease/conditio…
Update on InterQual Criteria
November 15, 2021
Health Partners Plans values your participation and is always working to provide clear, consistent utilization management guidance. As a reminder, Health Partners Plans uses McKesson’s InterQual® criteria as a guideline for making medical necessity …
Telehealth Policy Update (Health Partners Medicare)
November 2, 2021
Please be aware that HPP has created a telehealth policy (RB.021.A: Professional Telehealth Services Medicare) that impacts our Health Partners Medicare line of business. The updated policy can be found at our Policy Library. We are working on updat…
Register Now for Our Health Partners Medicare 2022 Benefits Overview Webinar
September 21, 2021
Health Partners Plans (HPP) continues to improve Health Partners Medicare by enhancing benefits, expanding our provider network and building stronger relationships with our in-network providers. Our 2022 Medicare Advantage plans provide comprehensiv…
Refer Your Adult Medicaid Patients to MANNA Today
September 20, 2021
Health Partners Plans (HPP) is dedicated to ensuring the health and wellness of our members. Since 2015, HPP has partnered with MANNA to provide medically tailored meals for our Health Partners (Medicaid) members with complex health care needs as wel…
The Fall Issue of Provider Check Up is Available Now!
August 17, 2021
The Fall edition of the Health Partners Plans provider newsletter, Provider Check Up, is now available on our website. Learn more about provider services and support, member benefits, upcoming education and training opportunities, disease/condition …
Reminder: Request Prior Authorization for Synagis
August 16, 2021
Respiratory syncytial virus (RSV) cases usually begin to be reported in the fall and taper off in the spring. According to the American Academy of Pediatrics (AAP), it isn’t know if RSV cases will increase during the fall and into winter, and it is n…
Health Partners Plans Continues to Provide Home Blood Draws to our Members
August 12, 2021
Recently, you may have received a communication from PTI Health advising Health Partners Plans made the decision to no longer cover the cost of home specimen collection. We are writing to inform you there have been no changes to our members' ability …
Diabetes and Cardiovascular Disease Screening and Monitoring for People With Schizophrenia or Bipolar Disorder
July 19, 2021
It is well established that adults with serious mental illness, including schizophrenia and bipolar disorder, have a higher mortality rate than the overall general population. The prevalent cardiovascular risk factors in this population are diabetes,…
Oncology Drug Prior Authorization Changes for Health Partners (Medicaid)
July 15, 2021
Health Partners Plans (HPP) is routinely examining our processes and protocols to identify opportunities where we can create efficiencies and minimize any administrative activities required of our providers. As a result, we are making the following c…
Upcoming Changes to HPP’s Claims Call Center
July 15, 2021
As you are aware, Health Partners Plans (HPP) migrated to a new claims platform starting in Fall 2019 and ending in Fall 2020. The transition went very well and HPP is already benefiting from efficiencies of a state-of-the-art claims platform. To al…
Tobacco Cessation and NRT Resources
July 12, 2021
Health Partners Plans is dedicated to providing quality health care and continually improving the health outcomes of our members. As you may know, tobacco use is the leading cause of preventable death and disease in the U.S., accounting for more tha…
The 2021 Provider Access, Appointment and Telephone Availability Standards Survey is Now Available
June 29, 2021
Health Partners Plans (HPP) strives to make the most of our partnership with our providers and members. Each year, HPP surveys our network to determine if our providers are meeting the Access and Appointment Standards and Telephone Availability Stand…
You're Invited to HPP's Medicare Health Outcomes Survey Webinar Series
June 28, 2021
Health Partners Plans (HPP) is here to help you navigate the quality measures related to improving patient health outcomes with a new webinar in our Health Outcomes Survey (HOS) series, scheduled for July 13, 2021. An HPP subject matter expert will …
You're Invited to HPP's Provider Roundtable on Uncontrolled Diabetes
June 2, 2021
Health Partners Plans is hosting a one-hour roundtable discussion about uncontrolled diabetes in Philadelphia’s African American populations on Wednesday, June 16 at 12:30 p.m. We encourage our network providers to attend and hear from local clinicia…
COVID-19 Update: Authorization Process Changes
June 1, 2021
As we see the COVID-19 health crisis improving throughout Pennsylvania, Health Partners Plans (HPP) will be changing some of its practices to align with the Pennsylvania Department of Human Services (DHS) Medical Assistance Bulletin 99-21-03, which w…
Check Out the Summer Issue of Provider Check Up
May 20, 2021
The Summer edition of the Health Partners Plans provider newsletter, Provider Check Up, is now available on our website. Learn more about provider services and support, member benefits, upcoming education and training opportunities, disease/conditio…
HPP Launches COVID Vaccine Report
May 13, 2021
Health Partners Plans (HPP) is pleased to announce the creation of the “COVID Vaccine Report.” This report will be posted every Tuesday on NaviNet and can assist you in identifying your patients who have received their vaccination. Please take the t…
Removal of Medical Necessity Review for Non-emergent Land Transportation
April 30, 2021
Effective immediately, Health Partners Plans (HPP) will temporarily suspend medical necessity review for non-emergent land transportation for our Health Partners (Medicaid) members only, which will remove the need to obtain an authorization for these…
Upcoming Webinars on Shift Care Staffing and Reporting
April 29, 2021
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…
Don't Miss Out on the Health Outcomes Survey Webinar Series
April 27, 2021
Health Partners Plans (HPP) is here to help you navigate the quality measures related to improving patient health outcomes with a new webinar in our Health Outcomes Survey (HOS) series, scheduled for May 11 and July 13. What will you gain by attendi…
Prior Authorization Issue Identified
April 26, 2021
Health Partners Plans (HPP) recently implemented a new care management system, which includes the management of our prior authorization requests. Prior authorizations submitted through our provider portal are then fed into our new care management sys…
COVID-19 Vaccine Administration - Updated Information Based on DHS Changes (April 23)
April 23, 2021
As promised in previous communications, we continue to monitor and update pricing related to COVID-19 vaccine administration. In response to a recent Pennsylvania Department of Human Services (DHS) Medical Assistance Bulletin released on April 19, 20…
Ordering Physician Notification for Pediatric Shift Care CPT Code S9122
April 23, 2021
On January 1, 2021, HPP became compliant with Section 12006 of the Twenty First Century Cures Act (Cures Act) and the Centers for Medicare & Medicaid Services (CMS) requiring the utilization of Electronic Visit Verification System (EVV) for all P…
HealthRules Care Manager Update – Different Look to HPP Authorization Numbers
March 29, 2021
Thank you for being a Health Partners Plans (HPP) participating provider. With the migration to a new medical management system this past weekend, your authorization numbers you receive via the provider portal will look a little different than in th…
Medicaid Medical Oncology Prescription Drug Prior Authorization Changes
March 29, 2021
Effective April 29, 2021, Health Partners Plans (HPP) will implement a change in our prior authorization process for outpatient chemotherapy and supportive drugs in our Medicaid plan. While you should continue to contact eviCore, our delegated vendo…
HealthRules Care Manager, New Utilization Management Platform, Launches March 29
March 24, 2021
After a successful transition to our new claims processing platform, HealthRules Payor (HRP) in 2020, HPP is moving to a new care management system, HealthRules Care Manager (HRCM), on Monday, March 29, 2021. This transition will allow HPP to conduct…
Philadelphia COVID-19 Vaccine Center Expands Access to Residents in Under-Vaccinated Zip Codes
March 17, 2021
The FEMA Center City Vaccination Center will provide open access to people from 22 under-vaccinated zip codes for six days. When is the open access at the Center City Vaccination Center happening? Between Wednesday, March 17 and Monday, March 22, 2…
New CMS OMH COVID-19 Vaccine Resources for Vulnerable Populations Webpage
March 15, 2021
This press release was first issued by CMS. The COVID-19 pandemic has disproportionately impacted minority and vulnerable populations. The COVID-19 vaccine can reduce the spread of the virus and help end the public health emergency. Community partne…
Elimination of Separate CHIP P.O. Box for Paper Claims and Claim Reconsiderations
March 4, 2021
Although Health Partners Plans (HPP) prefers that providers submit claims electronically using our Payer ID #80142, we recognize some providers may need to submit paper claims. To assist in the ease of submitting paper claims when needed, HPP will be…
The Spring Issue of Provider Check Up is Now Available!
March 3, 2021
The Spring edition of the Health Partners Plans provider newsletter, Provider Check Up, is now available on our website. Learn more about provider services and support, member benefits, upcoming education and training opportunities, disease/conditio…
Medicaid Check Cycle Delay
March 1, 2021
Thank you for being a Health Partners Plans participating provider. Due to an isolated technical issue, we are an expecting a 1-day delay in the Medicaid check cycle. We will keep you informed of any additional changes that may affect you during thi…
Complete the Annual D-SNP Model of Care Training
February 24, 2021
If your practice has at least one Health Partners Medicare Special (D-SNP) member assigned to its panel, then at least one person on your staff who is involved in the care of our dual-eligible special needs plan (D-SNP) members must complete our annu…
Participating Laboratory COVID-19 Testing Update
February 22, 2021
Health Partners Plans (HPP) recently identified a discrepancy in the reimbursement for COVID‐19 testing to participating laboratories. HPP corrected the discrepancy, retroactive to April 1, 2020, to reflect a payment equal to 100% of the Pennsylvani…
Non-Participating Laboratory COVID-19 Testing Update
February 22, 2021
Health Partners Plans (HPP) recently identified a discrepancy in the reimbursement for COVID-19 testing to non‐participating laboratories. HPP corrected the discrepancy, retroactive to April 1, 2020, to reflect a payment equal to 100% of the Pennsyl…
Policy Bulletin Update: RB.017.B Continuous Glucose Monitors
February 19, 2021
Health Partners Plans is updating an existing Policy Bulletin. Effective March 19, 2021, HPP will be implementing a revised policy for Continuous Glucose Monitors (CGM). Continuous glucose monitoring measures glucose levels in the interstitial fluid…
340B Hospital Billing Reminder
February 19, 2021
Health Partners Plans (HPP) would like to remind you that all billing requirements must be adhered to in order to ensure that required data is captured. To be accepted as a valid claim, the submission must contain correct current coding, including bu…
2021 Medicaid/CHIP Member Rewards
February 11, 2021
HPP is excited to announce the continuation of HPP Rewards, our popular incentive program for Health Partners (Medicaid) and KidzPartners (CHIP) members. All Medicaid and CHIP members will receive rewards points for completing specific health activit…
Capture Accurate ICD-10, HCPCS, CPT Coding at Annual Wellness Visit
February 10, 2021
Health Partners Plans (HPP) wants to address health risks faced by older populations and encourage our Medicare members to take charge of their health. The Annual Wellness Visit (AWV), added to the Medicare benefits by the Centers for Medicare &…
COVID-19 Vaccine Administration by Pharmacies
January 29, 2021
Health Partners Plans (HPP) will follow policies related to coding and reimbursement issued by the Centers for Medicaid & Medicare Services (CMS) and the Pennsylvania Department of Human Services (DHS). CVS/caremark, HPP’s contracted PBM, has im…
COVID-19 Vaccine Administration – Updated Information Based on DHS Changes
January 28, 2021
Health Partners Plans will follow both the Centers for Medicaid & Medicare Services (CMS) and the Pennsylvania Department of Human Services (DHS) policies related to coding and reimbursement. It is important to note that the reimbursement detail…
COVID-19 Antibody Therapy Administration
January 4, 2021
Please see the table below for the appropriate procedure codes to be used when billing Health Partners Plans (HPP) for COVID-19 antibody therapy administration to HPP members and the reimbursements applicable to those codes. HPP will follow both the …