Skip navigation

Sub-navProviders

False
Provider News
print

2024

Fluticasone HFA - Update to Preferred Drug List (PDL)

Thank you for your continuing efforts to improve the health outcomes of our members.  On January 18, 2024, you were advised that GlaxoSmithKline (GSK) has discontinued manufacturing Flovent HFA and Diskus as of December 31, 2023, and were provided a …

Read more

Provider Manual 2024 Update

Thank you for being a valued participating provider.  The Jefferson Health Plans’ Provider Manual, updated for 2024, has been finalized and is now available on our website at HPPlans.com/manual. As a reminder, the Provider Manual provides in-depth pl…

Read more

Change Healthcare Cyber Security Incident: FAQ

Change Healthcare Cyber Security Incident FAQs (Updated 06/5/2024) Member Eligibility, Billing & Payment Do you utilize any Change Healthcare or related products that might be impacted by the cyberattack? Yes, Jefferson Health Plans utilizes Chan…

Read more

Prior Authorization Update - CHIP

Thank you for being a valued Jefferson Health Plans provider. We are writing to inform you of an important update to the prior authorization requirements for our Health Partners Plans CHIP (KidzPartners) product.  Effective June 1, 2024, Jefferson He…

Read more

CAHPS & HOS Guidebook Updates

Jefferson Health Plans is focusing on improving patient satisfaction scores and elevating patients’ experience with their health plan and their providers. Jefferson Health Plans is committed to partnering with our network providers to elevate patient…

Read more

Summer 2024 Provider Check-up Newsletter is Now Available!

The Summer edition of the Jefferson Health Plans’ provider newsletter, Provider Check up, is now available on our website at hpplans.com/providernewsletter. In this issue, we provide information on the following topics: Change HealthCare Cyber Secur…

Read more

Bariatric Policy change

Thank you for being a valued participating provider. This letter is to inform you of an important change related to Elective Laparoscopic Sleeve Gastrectomy procedures for our Health Partners (Medicaid) and KidzPartners (CHIP) members.  Effective 7/1…

Read more

Updates to APR DRG version

Thank you for being a participating provider with Jefferson Health Plans. This letter contains important information about the update to the current version of APR-DRG. In accordance with the Pennsylvania Department of Human Services (DHS) and per Je…

Read more

Self-Monitoring Blood Pressure Cuffs for Pregnant Members

According to the Center for Disease Control and Prevention (CDC), 1 in every 12 to 17 pregnancies among women ages 20 to 44 in the U.S. experience high blood pressure. In addition, CDC data shows that black women are two to three times more likely to…

Read more

Quality Initiatives, Opportunities and Resources Webinar

Thank you for being a participating Jefferson Health Plans provider. You’re invited to participate in an upcoming webinar on Quality Initiatives, Opportunities and Resources on April 10, 2024. This webinar will offer insight from Jefferson Health Pla…

Read more

Smart Data Solutions Clearinghouse

Jefferson Health Plans has entered a partnership with Smart Data Solutions (SDS) Clearinghouse to accommodate Electronic Data Interchange (EDI) claim submissions for our two Payor IDs: Health Partners (Medicaid)/KidzPartners(CHIP)/Jefferson Health P…

Read more

Ancillary Provider Orientation and Training Announcement

Thank you for being a valued Jefferson Health Plans participating provider. Jefferson Health Plans is hosting our Ancillary Provider Orientation and Training webinar of 2024! The live webinar will be held on Wednesday, March 27, 2024, 12:30 to 1:30 p…

Read more

Spring 2024 Provider Check up Newsletter is Now Available!

The Spring edition of the Jefferson Health Plans’ provider newsletter, Provider Check up, is now available on our website at HPPlans.com/ProviderNewsletter. In this issue, we provide information on the following topics: Jefferson Health Plans Produc…

Read more

Change Healthcare Outage

On 2/21/24, Jefferson Health Plans was alerted by Change Healthcare about a network outage that is disrupting Change Healthcare’s ability to deliver services. This impacts providers who use Change Healthcare to send member eligibility verifications, …

Read more

PCMH Specialist 7-Day Follow-up

As a requirement of the DHS Patient-Centered Medical Home (PCMH) program, patients admitted with an ambulatory sensitive condition must be seen by the primary care PCMH provider or specialist provider within seven days of discharge from the hospita…

Read more

2024 Medicare Member Wellness Rewards

Jefferson Health Plans will continue to offer Wellness Rewards, our Medicare rewards program, to all Medicare members in 2024. Wellness Rewards incentivizes Medicare members to complete specific health-related activities to earn rewards dollars on a …

Read more

2024 MQCP Manual

Thank you for being a Jefferson Health Plans participating provider and for your continued participation in our Maternity Quality Care Plus (MQCP) program. MQCP is designed to recognize and reward your practice’s performance in delivering high-qualit…

Read more

2024 Individuals and Families Resources

We are pleased to announce the live recording and presentation for the 2024 Individuals and Families OEP webinars held in October 2023 are now published to the provider page of our website, in addition to a self-led eLearning course. As a reminder, t…

Read more

Blood Pressure Cuff Guidelines

Effective immediately, we have simplified ordering a blood pressure cuff for our Medicare, Medicaid, CHIP* and Individual and Families (Exchange) lines of business. We encourage you to provide guidance to your patients on the proper use of the blood …

Read more

Maternal Transthoracic Echocardiograms

Thank you for being a valued participating provider. We are writing to inform you that effective February 1, 2024, prior authorization for Maternal Transthoracic Echocardiograms (CPT 93306) will no longer be required when accompanied by a pregnancy d…

Read more

Expansion of CHIP Program Offering

Thank you for being a valued provider. We are excited to announce that we are expanding KidzPartners, our Children’s Health Insurance Program (CHIP). KidzPartners is now offered in all 67 counties across the Commonwealth of Pennsylvania. Jefferson He…

Read more

Billing/Regulatory guidance for Hospice providers

Thank you for being a Jefferson Health Plans’ participating provider. In preparation for upcoming provider monitoring that Jefferson Health Plans’ Special Investigation Unit will performing, we would like to make you aware of some recent findings of …

Read more