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2024

Winter 2024 Provider Checkup newsletter is now available!

Thank you for being a valued provider for members in one or more of our health plans: Health Partners Plans Medicaid, Health Partners Plans CHIP, Jefferson Health Plans Medicare Advantage, and/or Jefferson Health Plans Individual and Family Plans. Th…

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Maternity Care Program Updates for 2025

Thank you for being a valued provider for members in one or more of our health plans: Health Partners Plans Medicaid, Health Partners Plans CHIP, Jefferson Health Plans Medicare Advantage, and/or Jefferson Health Plans Individual and Family Plans. We…

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Closing Gaps in Medication Adherence - Webinar Announcement

Thank you for being a valued provider for members in one or more of our health plans: Health Partners Plans Medicaid, Health Partners Plans CHIP, Jefferson Health Plans Medicare Advantage, and/or Jefferson Health Plans Individual and Family Plans. We…

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Important Notice: Taxonomy Billing Policy Update

Thank you for being a valued provider for members in one or more of our health plans: Health Partners Plans Medicaid, Health Partners Plans CHIP, Jefferson Health Plans Medicare Advantage, and/or Jefferson Health Plans Individual and Family Plans. Th…

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Quality Care Plus (QCP) Program Updates for 2025

Thank you for being a valued provider for members in one or more of our health plans: Health Partners Plans Medicaid, Health Partners Plans CHIP, Jefferson Health Plans Medicare Advantage, and/or Jefferson Health Plans Individual and Family Plans. We…

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Postpartum Care in Collaboration with Latino Connection

We are excited to tell you about a collaborative initiative with Latino Connection to provide additional support and outreach to Health Partners Plans Medicaid’s mothers and families in the postpartum period. Latino Connection is a leader in outreach…

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New Shift Care Authorization Requirements

Thank you for being a valued provider for members in one or more of our health plans: Health Partners Plans Medicaid and CHIP plans, Jefferson Health Plans Medicare Advantage, and/or Jefferson Health Plans Individual and Family Plans. Effective Decem…

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Medicare Home Care Utilization Review Process

Below is an overview of CMS regulatory requirements as it relates to the Medicare home care utilization review process. Jefferson Health Plans is now enforcing these requirements for Medicare Advantage members; compliance is necessary to avoid disrup…

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Branding Update (October 2024)

As a reminder, in July of 2023 we launched Jefferson Health Plans as our official marketing name for certain Health Partners Plans, Inc. products. While the marketing name changed for certain products, others did not. Our product names that remained …

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Respiratory Illness Information

Respiratory illness season has officially begun, which runs during the fall and winter seasons. It’s important that all your patients be protected against respiratory illness during this season.  According to the Centers for Disease Control and Preve…

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Baby Partners Resources

We have developed a resource that provides more details about our Baby Partners program. This flyer can be shared within your office to all clinicians who interact with pregnant and postpartum members. Click here to download the flyer. Visit HPPlans.…

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HEDIS 2025 (Measurement Year 2024)

HEDIS reporting season is here! We need your support in collecting information from our members’ medical records for the 2024 reporting year. The focus of Healthcare Effectiveness Data and Information Set (HEDIS) is to measure the health plan’s perfo…

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Access to Care Plans for Medicare Advantage DSNP Members

In an effort to share information more effectively, effective October 1, 2024, Jefferson Health Plans Medicare Advantage DSNP member care plans will be available via the HealthTrio provider portal.  To access the member’s individual care plan report,…

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Synagis Prior Authorizations

Jefferson Health Plans will start the annual Synagis® Prior Authorization process on October 16, 2024, two weeks before the respiratory syncytial virus (RSV) season begins. Synagis® (palivizumab) is a monoclonal antibody indicated to prevent a severe…

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LetsGetChecked In-Home Kit Mailing

Jefferson Health Plans continues to partner with LetsGetChecked to mail FOBT and/or a combination A1c/kidney health evaluation kit to Medicare Advantage members who are non-compliant with their colorectal cancer screening and/or diabetes management t…

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2024 Wellness Rewards Reminder

Thank you for being a valued provider for members in one or more of our health plans: Health Partners Plans Medicaid, Health Partners Plans CHIP, Jefferson Health Plans Medicare Advantage, and/or Jefferson Health Plans Individual and Family Plans. Ea…

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Annual Orientation and Training Webinar Announcement

Thank you for being a valued provider for members in one or more of our health plans: Health Partners Plans Medicaid, Health Partners Plans CHIP, Jefferson Health Plans Medicare Advantage, and/or Jefferson Health Plans Individual and Family Plans. J…

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Fall 2024 Provider Checkup newsletter is now available!

Thank you for being a valued provider for members in one or more of our health plans: Health Partners Plans Medicaid, Health Partners Plans CHIP, Jefferson Health Plans Medicare Advantage, and/or Jefferson Health Plans Individual and Family Plans. Th…

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Duplicate Claims Payment

Jefferson Health Plans recently received an unusually high volume of claims through our clearinghouse, SDS. These claims were submitted to SDS through another trading partner and included a high volume of duplicate claims. Certain claims were inadver…

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Update to Prior Authorization Requirements - Sleep Studies

Thank you for being a valued participating provider.  In an effort to reduce the administrative burden around prior authorization requests, effective October 1, 2024, Jefferson Health Plans will no longer require prior authorization for Sleep Studies…

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Department of Human Services Mobile Clinic Survey

Health Partners Plans and Jefferson Health Plans, on behalf of the Pennsylvania Department of Human Services (DHS), would like to announce the launch of a survey DHS is conducting to gather more information on Mobile Health Clinics. If your organizat…

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Newborn Stay Authorization Policy Update

Thank you for being a Jefferson Health Plans participating provider. Jefferson Health Plans is revising our authorization policy for obstetrical delivery and NICU nursery care. In July 2021, Jefferson Health Plans implemented an authorization policy …

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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 l…

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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…

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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…

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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…

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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…

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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…

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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…

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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…

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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…

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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…

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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…

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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…

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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, …

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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…

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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 …

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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…

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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…

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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 …

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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…

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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…

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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 …

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