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2023

Benefits/Coverage for Beyfortus and Abrysvo

Thank you for being a Health Partners (Medicaid) and/or KidzPartners (CHIP) provider. This notice provides important information on the benefits/coverage for the vaccines Beyfortus and Abrysvo, both used in the treatment of RSV in children. Beyfortu…

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2024 Medicare Benefits AEP webinar/training

Thank you for being a Jefferson Health Plans provider. We are pleased to announce the live recording and presentation for the 2024 Medicare AEP webinars that were held earlier in October are now published to the provider page of our website, in addit…

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2024 Member ID Cards

Thank you for being a valued participating provider. As you are aware, in July of 2023, we officially launched our new corporate marketing name, Jefferson Health Plans*. As mentioned in previous communications, we are taking a phased approach and hav…

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Policy Bulletin Library

Thank you for being a Jefferson Health Plans participating provider. We are contacting you today to inform you of a revised policy available in our Jefferson Health Plans Policy Bulletin Library. Effective December 20, 2023, Jefferson Health Plans w…

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Q4 Provider Orientation and Training Webinar

Jefferson Health Plans is hosting our 4th quarter provider orientation and training webinar of the year on December 13, 2023. Jefferson Health Plans requires all participating providers to demonstrate that they are knowledgeable and trained on impo…

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Breast Pumps Guidelines

Thank you for being a participating Jefferson Health Plans provider. Effective immediately, Jefferson Health Plans has updated their dispensing guidelines for members needing a breast pump. Members are eligible to receive an electric breast pump beg…

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The Winter Issue of Provider Check Up is Now Available!

The Winter edition of the Health Partners Plans provider newsletter, Provider Check Up, is now available on our website. Learn more about provider services and support, member benefits, upcoming education and training opportunities, disease/conditio…

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Quality Care Plus (QCP) Program Updates for 2024

Thank you for being a Jefferson Health Plans participating provider and for your continued efforts to help manage the health of our members. We greatly appreciate the relationships we have built with our provider partners. We acknowledge that the wor…

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Maternity Quality Care Plus (MQCP) Updates for 2024

Thank you for being a participating Jefferson Health Plans provider. We have successfully completed another year of the Maternity Quality Care Plus (MQCP) program, which is designed to recognize and reward your practice’s performance throughout the y…

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NEW Payor ID for Medicare PPO

Thank you for being a valued Jefferson Health Plans provider. Please be advised of the addition of a payor ID for the electronic submission of Medicare PPO claims, as well as the mailing address for paper claims submissions. This will only apply to J…

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HEDIS 2024 (Measurement Year 2023)

HEDIS reporting season is here! Jefferson Health Plans needs your support in collecting information from our members’ medical records for the 2023 reporting year. The focus of Healthcare Effectiveness Data and Information Set (HEDIS) is to measure t…

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Flu Resources for 2023-2024

Flu season has officially begun. It’s important that all your patients be vaccinated during the early months of flu season. Jefferson Health Plans is encouraging all members to be vaccinated by the end of October. Vaccination by Age Group Everyone …

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Now Available: Comprehensive Pediatric Education Packet

Thank you for being a Jefferson Health Plans participating provider. We are contacting you today to share new and updated materials to assist you in caring for Jefferson Health Plans’ Pediatric members. The Comprehensive Pediatric Education Packet i…

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Risk Adjustment 2024 Changes

At Jefferson Health Plans, we want to remind you that selecting the correct ICD-10 codes contributes to a more accurate picture of the patient’s health status, which can have a positive effect on payment and risk score. Earlier this year, the Center…

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D-SNP Plan MOC Medicare Training Provider Webinar

Thank you for being a participating Jefferson Health Plans provider. You have been identified as a provider who has at least one Health Partners Medicare Special (D-SNP) member assigned to your practice. As a result, at least one person on your staff…

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Provider Intake Survey Tool

We want to hear from you! Jefferson Health Plans has developed a short, easy to use, online survey to learn more about your practice so that we can better identify ways to collaborate on shared goals, quality initiatives and better outcomes for your …

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Jefferson Health Plans and PCDC Webinar Series

Jefferson Health Plans is hosting a series of three webinars in collaboration with practice transformation consultant, Primary Care Development Corporation (PCDC). We invite you and your team to participate in the Member Satisfaction and Customer Ser…

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Medicare 2024 Benefits AEP Webinars

Thank you for being a Jefferson Health Plans participating provider. As announced in an earlier communication, Jefferson Health Plans will also be expanding our Medicare product offerings to include a Medicare Advantage Preferred Provider Organizatio…

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Policy Bulletin Library: Ambulance Ground Mileage.

Thank you for being a Jefferson Health Plans participating provider. We are contacting you today to inform you of a revised policy available in our Jefferson Health Plans Policy Bulletin Library. Effective August 15, 2023, Jefferson Health Plans wil…

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Access and Availability Survey Reminder

Thank you for your participation in the Jefferson Health Plans network and helping to meet the medical needs of our members. Each year, Jefferson Health Plans surveys our network to determine if primary care and specialist providers are meeting the …

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Introducing Jefferson Health Plans PPO Products

Jefferson Health Plans would like to introduce our Medicare Advantage Preferred Provider Organization (PPO) products. We are excited to offer these products to eligible Medicare beneficiaries in our current Pennsylvania Medicare service area beginnin…

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Participating Providers’ Access to Information

Jefferson Health Plans strives to deliver the highest level of service across our provider network through education and resources necessary in providing the highest quality of care to our members. This notice is to reiterate the availability of the…

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2023 Medicare Wellness Rewards Program Reminder

Earlier this year, Jefferson Health Plans notified providers of the Medicare Wellness Rewards program for our Health Partners Medicare members. This is a reminder that members must complete all eligible health activities and rewards must be redeemed …

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DHS Electronic Visit Verification (EVV) effective 10/1/2023

We are writing to inform you that a Department of Human Services (DHS) statewide mandate will change how Jefferson Health Plans processes Electronic Visit Verification (EVV) authorizations. Effective 10/1/2023, Jefferson Health Plans EVV authorizati…

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Register Now for Provider Orientation and Training Webinar

Jefferson Health Plans is hosting our 3rd Quarter provider orientation and training webinar of the year on September 20, 2023. Jefferson Health Plans requires all participating providers to demonstrate that they are knowledgeable and trained on imp…

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Synagis Prior Authorizations

Jefferson Health Plans will start the annual Synagis® Prior Authorization process on October 16, 2023, two weeks before the respiratory syncytial virus (RSV) season begins. Synagis® (palivizumab) is a monoclonal antibody indicated to prevent severe l…

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The Fall Issue of Provider Check Up is Now Available!

The Fall edition of the Health Partners Plans provider newsletter, Provider Check Up, is now available on our website. Learn more about provider services and support, member benefits, upcoming education and training opportunities, disease/condition …

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High Performer Recognition Program

In June 2023, we provided more details about Jefferson Health Plan’s new High Performer Recognition Program. We are excited to announce the first group of practices that will be recognized for high quality performance based on HEDIS measure perform…

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Ancillary Provider Orientation and Training

You spoke, we listened! Due to your feedback, we have created our first Ancillary Orientation and Training.  We will host our live webinar on Wednesday, August 30, 2023, 12:30 p.m. – 1:30 p.m. tailored to the services provided by the below provider…

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Home Healthcare Authorizations Update

Jefferson Health Plans' home healthcare authorizations will not be loaded into the HHAX system for our soft go-live on Monday, August 14, 2023. Jefferson Health Plans will be working to provide these authorizations within the next week. We will provi…

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Vaccine Coding and Reimbursement REVISED

We are writing to inform you of an update regarding the reimbursement of vaccines and the related administration for Jefferson Health Plans. Coding and Reimbursement Change Effective September 1, 2023, the vaccine administration fee will be reimbur…

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Prior Authorizations for Opioid Prescriptions: Updates

Thank you for your continuing efforts to improve the health outcomes of our members. This letter is to inform you of the changes the Department of Human Services (DHS) announced to prior authorization guidelines for Analgesics, Opioid Long Acting and…

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Well-Child Visit Reminder and Clarification

One of Jefferson Health Plans’ primary goals is to ensure our youngest members receive the preventive care they need. That’s why we want to remind you that you can complete a well-child visit once every year, even if 365 days have not yet passed sinc…

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Talking to Your Patients about Vaccinations

This August, we recognize National Immunization Month. It is a friendly reminder that not only children need to be up to date on vaccinations, but also adolescents, adults, and expectant mothers. Nationally recommended vaccines can offer continuous i…

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Shortage and Availability of Ziextenzo

Given the growing concerns about the shortage and availability of Ziextenzo (pegfilgrastim-bmez) in the Colony Stimulating Factors therapeutic class, DHS is changing the status of Fulphila (pegfilgrastim-jmdb) to preferred effective 7/12/2023 on the …

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Notification Regarding July 4th Holiday Hours

In observance of the July 4th Holiday, Health Partners Plans will have modified hours of operations starting Monday, July 3, 2023. Provider Services Helpline. The Provider Services Helpline will operate under normal business hours on Monday, July …

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Policy Notification: Retirement of Gattex

We are contacting you today to inform you of the retirement of a policy available in our HPP Policy Bulletin Library. Effective August 1, 2023, HPP will be reitre the following drug policy: DR.012.B Gattex. You can access this policy by visiting our…

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Policy Notification: Reduction Mammoplasty

We are contacting you today to inform you of a new policy available in our HPP Policy Bulletin Library. Effective August 1, 2023, HPP will be implementing a new medical policy: N.022.A Reduction Mammoplasty. You can access this policy by visiting ou…

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Vaccine Coding and Reimbursement

We are writing to inform you about the reimbursement of vaccines and the related administration for Health Partners Plans (HPP). Coding and Reimbursement Change Effective September 1, 2023, the vaccine administration fee will be reimbursed on the a…

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Tobacco Cessation: Asking About Readiness to Quit

In 2022, Community Behavioral Health (CBH) conducted surveys that found patients are significantly more interested in quitting tobacco use than providers believed and that current provisions of tobacco use disorder treatment are not meeting patient n…

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HPP's New High Performer Recognition Program

Thank you for being a Health Partners Plans (HPP) participating provider and for your continued efforts to help manage the health of our members. We greatly appreciate the relationships we have built with our provider partners. HPP acknowledges the w…

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Provider Orientation and Training Webinar (June 21)

HPP is hosting our 2nd quarter provider orientation and training webinar of the year on June 21, 2023. HPP requires all participating providers to demonstrate that they are knowledgeable and trained on important topics and participate in at least o…

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CAHPS & HOS Guidebook

Health Partners Plans (HPP) is partnering with our network providers to improve patient satisfaction with their health plan and providers, and to elevate the patient in-office experience. Our goal is supporting practices like yours in optimizing the…

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The Summer Issue of Provider Check Up is Now Available!

The Summer edition of the Health Partners Plans provider newsletter, Provider Check Up, is now available on our website. Learn more about provider services and support, member benefits, upcoming education and training opportunities, disease/conditio…

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Medicare Payment Delay

For the week of 5/22/2023, we are experiencing a 1-day delay in Medicare payment processing. For any questions, please contact the Provider Services Helpline at 1-888-991-9023 (Monday to Friday, 9 a.m. – 5:30 p.m.).

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HPP Policy Bulletin: Zolgensma

Thank you for being a Health Partners Plans (HPP) participating provider. We are contacting you today to inform you of a revised policy available in our HPP Policy Bulletin Library. Effective 6/23/2023, HPP will be implementing a revised drug policy…

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Reminder: Tobacco Cessation Program

Health Partners Plans (HPP) would like to remind providers that per MA Bulletin 99-18-10 titled “Enrollment of Tobacco Cessation Providers,” an individual or entity must be approved by the Pennsylvania Department of Health (DOH) as a Tobacco Cessatio…

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Home Visiting Programs for Pregnant Members/New Parents

Thank you for being a Health Partners Plans (HPP) participating provider. HPP encourages in-network providers to refer pregnant members and new parents to an evidence-based home visiting program. All pregnant HPP members, and parents/guardians of ch…

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Guidance for Billing Avastin for Ophthalmic Use

Health Partners Plans would like to provide guidance to our network regarding billing Avastin for Ophthalmic indications. The table below provides accepted coding and requirements for reimbursement consideration for each. Code Definitio…

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Announcing a Well Child Incentive Program

Health Partners Plans (HPP) would like to make you aware of anopportunity to earn additional incentive dollars on well-child visits for patients ages 11-21 from July 1, 2023, through December 31, 2023. Important Note: You MUST opt in no later than M…

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Member Redetermination Data Available

As you may know, effective April 1, 2023, the Pennsylvania Department of Human Services (DHS) returned to pre-pandemic renewal processing procedures for Medical Assistance and CHIP. All Medical Assistance and CHIP recipients need to complete an annua…

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HPP Policy Bulletin: Gene Therapy

Health Partners Plans would like to inform our provider partners of a revised policy available in our HPP Policy Bulletin Library. Effective May 24, 2023, HPP will be implementing a new drug policy: DR.014.A Gene Therapy. You can access this policy …

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Vaccine Claim Processing Issue Identified

We have identified an issue when processing claims for vaccines which are resulting in inaccurate payments and/or denials. We are working to resolve the issue and will reprocess any claims requiring reprocessing.  There is no need to reach out to us …

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Announcing Our Pediatric Shift Care Incentive Program

Health Partners Plans (HPP) would like to make you aware of a new incentive program for pediatric nursing shift care services. The incentive went into effect on January 1, 2023 and is available to in-network home care providers. Home care agencies w…

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HPP's 2023 Member Rewards Programs (Medicaid and CHIP)

Thank you for being a Health Partners Plans (HPP) participating provider.HPP would like to remind you about the HPP Rewards program that encourages Health Partners (Medicaid) and KidzPartners (CHIP) members to complete targeted health condition manag…

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HPP Policy Bulletin: DPP

Health Partners Plans would like to inform our provider partners of a revised policy available in our HPP Policy Bulletin Library. Effective May 8, 2023, HPP will be implementing a revised claim payment policy: RB.029.B Diabetes Prevention Program. …

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You're Invited: P4P Webinars

Thank you for being a participating Health Partners Plans (HPP) provider. You’re invited to participate in an upcoming webinar on HPP’s quality program, which rewards your practice’s performance for delivering quality services to our members. Please …

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Maternity Home Care Visits Coding

Thank you for being a Health Partners Plans participating provider and an active partner in our Baby Partners program. This program allows for home care visits by an in-network Home Care Agency to promote a healthy pregnancy and safe transition home …

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Telehealth for OB Services

Health Partners Plans recognizes the value of face-to-face provider visits to foster the patient/provider relationship, and we also know that telehealth provides a way to promote patients’ engagement in their health care.  The use of telehealth servi…

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Osteoporosis Management Measure

Thank you for being a Health Partners Plans (HPP) participating provider and for your continued efforts to manage our members’ health. HPP would like to share some helpful information about the Osteoporosis Management in Women Who Had a Fracture (OMW…

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Medication Management Support for Medicare Members

Health Partners Plans (HPP) is committed to helping our Medicare members manage chronic conditions through medication support and adherence activities. HPP would like to remind you that we have several resources to assist both you as providers and y…

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Provider Orientation and Training Webinar

Thank you for being a Health Partners Plans (HPP) provider. HPP is hosting our first provider orientation and training webinar of the year on March 22, 2023.HPP requires all participating providers to demonstrate that they are knowledgeable and tr…

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Screening for Colorectal Cancer Saves Lives

In the spirit of Colorectal Cancer Awareness Month, Health Partners Plans (HPP) would like to remind you of recently expanded coverage for colorectal cancer screening. A number of screenings are covered for Medicare and Medicaid members as preventi…

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Member Satisfaction with Provider Survey and QCP Changes

Member satisfaction remains a top priority for Health Partners Plans (HPP).We have seen an increase in the overall average scores within our QCP program due to your efforts to address member satisfaction. However, we acknowledge that there is still r…

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Meals as Medicine

Health Partners Plans (HPP) is dedicated to ensuring the health and wellness of our members. Since 2015, HPP has partnered with MANNA to provide medically tailored meals for Health Partners (Medicaid) members with complex health care needs, as well a…

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Utilizing Telehealth to Improve Patient Access

Health Partners Plans (HPP) encourages all providers to utilize telehealth when appropriate to improve and expand patient access to care. We want to narrow the gap for members to utilize telehealth services. Challenge The lack of universal access…

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The Spring Issue of Provider Check Up is Now Available!

The Spring edition of the Health Partners Plans provider newsletter, Provider Check Up, is now available on our website. Learn more about provider services and support, member benefits, upcoming education and training opportunities, disease/conditio…

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Help Medical Assistance and CHIP Members Maintain Coverage

As you may know, effective April 1, 2023, the Pennsylvania Department of Human Services (DHS) will return to normal renewal processing procedures for Pennsylvanians enrolled in Medical Assistance and CHIP. All Medical Assistance and CHIP recipients w…

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HPP Policy Bulletin: Relizorb

Thank you for being a Health Partners Plans (HPP) participating provider. We are contacting you today to inform you of a new policy available in our HPP Policy Bulletin Library. Effective 3/22/2023, HPP will be implementing a new drug policy: RB.013…

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New Online Provider Directory Announcement

Health Partners Plans is continuously working to improve our provider experience. Our goal is to ensure administrative ease and allow maximum time to care for their patients. With that in mind, we are excited to announce a new online provider directo…

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HPP Policy Bulletin: Maternity Billing and Guidelines

We are contacting you today to inform you of a new policy available in our HPP Policy Bulletin Library. Effective 3/15/2023, HPP will be implementing a new claim payment policy: RB.031.A Maternity Billing and Guidelines. You can access this policy b…

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2023 Health Partners Medicaid Benefit Update: $0 Copays

In an effort to reduce barriers to care for our Medicaid population, effective January 1, 2023, Heath Partners Plans has adopted a $0 copay for all medical benefits for our Health Partners (Medicaid) health plan. We believe that greater access and lo…

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Register Now: Provider Education on Women's Health

Thank you for being a participating Health Partners Plans (HPP) provider. You’re invited to participate in an upcoming HPP webinar on women’s healthcare issues on January 27, 2023. This webinar will explain three measures that are included in the Na…

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Notification of Changes in Medicare Part D Program Coverage

HPP is notify you of upcoming changes to Health Partners Medicare’s Part D program coverage. These changes were prompted by the Inflation Reduction Act (IRA), which contains widespread changes to the Medicare program that have taken effect starting i…

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2023 Ambulance Fee Increases

Thank you for being a Health Partners Plans (HPP) participating provider and for your continued efforts to manage our members’ health. Effective for dates of service on and after January 1, 2023, the Department of Human Services (DHS) will increase …

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