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Provider Education Self-Management Tools

These online classes were created to keep you informed on a variety of important topics. Click on a course below to start, and please be sure to complete an attestation once the courses are completed.

Provider Orientation and Training

Providers who are contracted with Jefferson Health Plans must demonstrate that they are knowledgeable and trained on important topics annually. Participation in our quarterly provider orientation and training course satisfies this annual requirement. The course offers a detailed overview of Jefferson Helath Plans and gives valuable information to meet the needs of our members. Topics include: product overview; claims filing instructions and best practices; Community HealthChoices program; access and availability standards; Pay-for-Performance and QUality Care Plus; EPSDT standards; and member ID cards.

Cultural Competency and Linguistic Requirements and Services

During this course you’ll learn how to access our clinical programs and resources for patients, including:
• Identification and appropriate referral for mental health
• Drug and alcohol and substance abuse services
• Sensitivity training on diverse and Special Needs populations such as persons who are deaf or hard of hearing
• How to obtain sign language interpreters and how to work effectively with sign language interpreters.
Also Cultural Competency and Treating Special Needs populations, including the right to treatment for individuals with disabilities.

Complaints, Grievances and Medical Necessity Reviews

Part 1 of this course offers information to providers regarding the Medicaid and CHIP Member Complaint and Grievance process, and how providers can submit Complaint and Grievance requests to the Plan on behalf of their patients who are Plan members. Part 2 of this course offers information to providers regarding the Medicaid and CHIP Member Utilization Management Authorization request process, and the need to provide supporting clinical documentation and orders required for a medical necessity review.

Overview of 2024 Medicare Advantage Products

This course provides an overview of Jefferson Health Plans’ Medicare Advantage Plans, and an understanding of the values/benefits Jefferson Health Plans Medicare offers our members. Topics include copay and prescription drug coverage, and enhanced supplemental benefits such as vision, dental, flex cards, transportation and much more.

Jefferson Health Plans: Individual and Family 2024 Plan Year overview:

This course is designed to give you an overview of the Jefferson Health Plans Individual and Family product. The enrollment process will be explained, as well as a summary of the 10 new Individual and Family plans offered in Bucks, Montgomery and Philadelphia counties.