Sunday, March 14, 2010
   
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Provider Services

Welcome Health Plan Providers.

Are you connected? You can check member eligibility, review claims, review referrals and precertifications using our secure Provider website. Customer Service Representatives are available for you to contact. Their numbers are listed on the left hand side of this webpage.

Find providers using our Provider Search. Search for NPI# using the National NPI Search. View Pharmacy benefit information, newsletters and important pharmacy news updates.

Within this website, you will find resources that you as a Provider can utilize to help you answer your questions. Make sure you check out The Health Plan Provider Manual. It gives you an overview of The Health Plan and its structure so that you can function more effectively as a provider.

If you have questions or need help, call us in the Ohio Valley/Mountaineer Region at 1.800.624.6961, Monday through Friday from 8:30am to 5:00pm or 1.800.426.9013 in the HomeTown Region, Monday through Friday from 8:00am to 5:00pm. You can also This e-mail address is being protected from spambots. You need JavaScript enabled to view it us.

Access Provider Files & Forms 

 

Medicare Fraud, Waste and Abuse Training

All healthcare practitioners/providers or staff who render healthcare services to Medicare Advantage enrollees or who administer the Medicare Part D Prescription Drug benefit, must complete Fraud, Waste and Abuse (FWA) Training by December 31, 2010 and annually there after.

The training must be documented by the healthcare providers and captured by The Health Plan as well as other health plans with Medicare Advantage plans.

The training is to be completed once per year by December 31. The training will be accepted if taken on the CMS MedLearn website, or FWS training provided through your organization. If you or your staff have completed Fraud, Waste and Abuse Training through another healthcare provider or entity, this will suffice. All healthcare practitioners/providers and employees that have taken the training need to attest to the completion of the training by completing The Health Plan Attestation Form.

Once you and your staff have completed your training, complete the 2010 Health Plan - Fraud, Waste and Abuse Training Attestation Form. Please understand, CMS, The Health Plan and/or other health plans may require addition information to substantiate the completion of the training.

We have also included a Slide Presentation on FWA, a testing tool and answer key if you choose to measure the training by you and your staff. This is NOT a requirement and does not need to be returned to The Health Plan. please see the below attachments to access this important and helpful information.

Access Additional FWA Files & Forms


   

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Ohio Valley/Mountaineer Region
TF: 1.800.624.6961
Email: hpecs@healthplan.org
Hours: Mon- Fri., 8:30 am to 5:00 pm

HomeTown Region
TF: 1.800.426.9013
Email: hpecs@healthplan.org
Hours: Mon- Fri., 8:00 am to 5:00 pm

 

Resources for Providers

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