Eligibility and Claims

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Providers

Find tools and resources to help with eligibility, billing and claims on the provider portal.

Access Provider Portal

Still have questions? See below for more information.

Claims Processing Information

Request for Claim Reconsideration

HIPAA Connect

Claims Forms and Addresses

Frequently Asked Questions

Our Utilization Management guidelines can be found in our provider manual.

Information on how Jefferson Health Plans makes decisions about coverage of new medical technology can be found in our provider manual.

Members have the right to know about their rights and responsibilities. Exercising these rights will not negatively affect the way they are treated by Jefferson Health Plans, its participating providers or other State agencies. A full description of Member Rights and Responsibilities can be found in our provider manual.

Still have questions? See below for more information.

How do Jefferson Health Plans and Health Partners Plans help to ensure access to appropriate health services?

How do you evaluate coverage of new medical technology?

What rights and responsibilities do members have?