2024
Bariatric Policy change
April 26, 2024
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…
Updates to APR DRG version
April 5, 2024
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…
Self-Monitoring Blood Pressure Cuffs for Pregnant Members
April 4, 2024
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…
Jefferson Health Plans and You: Enhancing Patient Experience Webinar
March 29, 2024
Jefferson Health Plans is hosting a webinar in collaboration with ProspHire, a healthcare focused management consulting firm, that will focus on the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey and best practices recommendat…
Change Healthcare Cyber Security Incident: FAQ
March 26, 2024
Change Healthcare Cyber Security Incident FAQs (Updated 03/26/2024) 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 Cha…
Quality Initiatives, Opportunities and Resources Webinar
March 22, 2024
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…
Smart Data Solutions Clearinghouse
March 15, 2024
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…
Ancillary Provider Orientation and Training Announcement
March 5, 2024
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…
Provider Annual Orientation and Training Webinar Announcement
March 5, 2024
Jefferson Health Plans is hosting our first provider orientation and training webinar of the year on March 20, 2024. Jefferson Health Plans requires all participating providers to demonstrate that they are knowledgeable and trained on important topic…
Spring 2024 Provider Check up Newsletter is Now Available!
February 28, 2024
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…
Change Healthcare Cyber Security Incident: Authorization Process Update
February 23, 2024
As recently communicated, on February 21, 2024, Jefferson Health Plans was alerted by Change Healthcare about a cyber security incident they’ve experienced that is disrupting Change Healthcare’s ability to deliver services. We will continue to monito…
Change Healthcare Outage
February 22, 2024
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, …
Women’s Health Measures & Maternity Quality Care Plus (MQCP)
February 16, 2024
Thank you for being a participating Jefferson Health Plans provider. You’re invited to participate in an upcoming webinar on women’s healthcare topics on Wednesday, February 28, 2024. This webinar will review important details related to Jefferson He…
PCMH Specialist 7-Day Follow-up
February 15, 2024
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…
2024 Medicare Member Wellness Rewards
February 5, 2024
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 …
2024 MQCP Manual
January 31, 2024
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…
2024 Individuals and Families Resources
January 30, 2024
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, …
Blood Pressure Cuff Guidelines
January 30, 2024
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…
Jefferson Health Plans 2024 Medicare & Individuals and Families Webinar
January 29, 2024
You're invited to an upcoming Jefferson Health Plans’ Medicare/Individuals and Families (IFP) webinar. Our team will provide a review of the Medicare Advantage & IFP products and other guidelines, including: Medicare Advantage produc…
Pennsylvania Statewide Preferred Drug List - Asthma Inhaler Coverage
January 18, 2024
Thank you for your continuing efforts to improve the health outcomes of our members. This letter is to inform you that GlaxoSmithKline (GSK) has discontinued manufacturing Flovent HFA and Diskus as of December 31, 2023. For our Health Partners (Medic…
Maternal Transthoracic Echocardiograms
January 16, 2024
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…
Expansion of CHIP Program Offering
January 16, 2024
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 H…
Billing/Regulatory guidance for Hospice providers
January 5, 2024
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 …
Policy Notification: Professional Telehealth Services (Individual and Family Plans)
January 5, 2024
Thank you for being a Jefferson Health Plans participating provider. We are contacting you today to inform you of a new policy available in our Jefferson Health Plans Policy Bulletin Library. Effective January 1, 2024, Jefferson Health Plans will be…