PROVIDERS

Frequently Asked Questions about Members’ Care

Do you want to know more about Health Partners and how we work to assure high quality health services for our members? Click on any of the bullets on this page to get answers to your questions.

• What is Health Partners’ Quality Management program? What are its 2012 goals?
• How does Health Partners help assure access to appropriate health services?
• How does Health Partners evaluate coverage of new medical technology?
• What can I do if Health Partners denies a requested item or service?
• How can I discuss a decision with a Health Partners medical director? Health Partners medical directors are available to discuss utilization review decisions with peers by calling 215-967-4570.
• What are Health Partners’ access and appointment standards for participating providers?
• Where can I find information about member satisfaction with Health Partners?
• What rights and responsibilities do Health Partners members have? What are the KidzPartners member rights and responsibilities?
• How can I get information about providers that participate with Health Partners or KidzPartners? Our online provider directory offers the most current information available about our network of primary care physicians, specialists, hospitals, designated radiology and lab facilities, DME providers and much more. Please use this directory when providing referrals/scripts for our members. (A Spanish version of this tool is also available on our Health Partners and KidzPartners member websites.)

We hope you’ll find that the Provider Manual, Clinical Guidelines and other content on our website offer a wealth of information. We’re always ready to answer any additional questions you may have about coverage, claims, and how to work with our health plan. Call us anytime at 215-991-9023 or toll-free at 888-991-9023, or contact your Network Account Manager.