Provider News
Jefferson Health Plans Rebranding
All of our health plans are now together under one name: Jefferson Health Plans.
Clinical Updates
Referring Members for Case Management
Help families effectively navigate the healthcare system by referral to case management services.
HPV Self-Collection Test
An FDA‑cleared alternative for provider use in clinical or other healthcare settings is now available.
Asthma Spacers
You can encourage the use of spacers in young children as a key part of asthma therapy.
Behavioral Health Training for Primary Care Providers
A free on-demand training series is available to strengthen your ability to treat patients with behavioral health needs..
Promoting Childhood Immunization Standards
Learn about updated CDC recommendations to help ensure children's health.
Notices & Reminders
Cultural and Linguistic Requirements and Services for Members
Providers have a responsibility to provide patient service in a culturally and linguistically appropriate manner.
Reporting an Issue of Compliance, Privacy, or Fraud
Reporting incidents of compliance, privacy or fraud helps create a culture of honest and ethical behavior.
Data Validation
Keep your information up-to-date by checking the DHS PROMISe system to confirm your demographic data.
Accurate NPI Required for Post-Acute Referrals
Referrals must reflect the most up-to-date details to help us confirm network status and support placement.
Quality of Care
Engaging Patients: Health Outcomes Survey (HOS) Measures
Providers can make a difference by engaging in the survey and regularly discussing its topics with members.
Quality Management: Provider Referral Line
We offer a toll-free, anonymous provider line to report preventable, serious and adverse events.
In-Home Screenings: Provider Referral Process
We continue to provide in-home screenings and evaluations for certain HEDIS measures critical to member health.
Medicare Wellness Rewards Program
Encouraging your Medicare patients to complete specific health-related activities can help you improve your performance on QCP measures.
What to Expect: Quality Medical Record Requests
Throughout the year, you may receive time-sensitive medical records requests that require your response.
ACA P4P Provider Incentive Program
Primary care providers are eligible to earn incentive payments for their performance on HEDIS measures.
Pharmacy Pulse
Pharmacy Formulary Changes
The most recent formulary, prior authorization, quantity limit and age edit updates.
Dental Dispatch
Oral Health is Prenatal Care
Many pregnant patients still do not get the dental care they need.
Fraud, Waste and Abuse
Updated Reporting Options for Fraud, Waste, and Abuse
Jefferson Health Plans is transitioning to a new hotline system for reporting potential Fraud, Waste and Abuse.