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Providers
Provider Education Self-Management Tools Certificate Program

We have created online classes to keep providers informed on a variety of important topics. Click on a course below to start.

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Course What to Expect 
Provider Orientation and Training Providers who are contracted with us 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 Health Plans and Health Partners Plans and provides valuable information to meet the needs of our members. Topics include: claims information, member ID cards, online tools and prior authorization guidelines.
Timely Filing Protocols and The Reconsideration Process This course provides an overview of our 180-day process for submitting or resubmitting claims for proper review and/or processing within an accurate time frame. Topics also include an overview of the claims reconsideration appeals process with the steps and appropriate documentation needed for review and determination.
Cultural Competency and Linguistic Requirements and Services This course teaches you 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 and how to obtain sign language interpreters and work effectively with sign language interpreters. The course also includes information on 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 provides information regarding the Medicaid and CHIP member complaint and grievance process and teaches providers how to submit complaint and grievance requests to us on behalf of their patients who are 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.
Contact Us

If you have questions about online courses or provider training, please call 1-888-991-9023 or email providereducation@jeffersonhealthplans.com. 

Frequently Asked Questions

To view the upcoming webinar schedule or download a previous webinar, please click here.

To view additional Jefferson Health Plans tools and resources for providers, click here. You can also log in to the provider portal for more information.

To view our provider manual, which includes up-to-date policies and procedures, click here.

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