Members enrolled in our HMO and POS products are required to select a Primary Care Physician (PCP) who acts as the coordinator of care for the patient. Members must contact their PCP prior to making appointments with specialty providers. Upon assessment of the patient needs, the PCP may find it appropriate to refer the patient to other participating specialty providers.
The Health Plan contracts with providers in order to obtain quality care at an affordable price. This enables us to contain premium increases to our membership. All services that can be properly performed by Health Plan providers must be referred in-plan. Services, which are not available through this in-plan network require preauthorization via an out-of-plan referral.
Provider Manual (2.8MB)
The purpose of this manual is to give you an overview of The Health Plan
and its structure so that you can function more effectively as a provider.
In addition to this manual and the training that accompanies it, The Health Plan Customer Service Representatives are always available to assist in any way possible by calling 1.800.624.6961/740.695.7901 for the Ohio Valley and Mountaineer Regions and 1.888.830.4370/740.330.4370 for the HomeTown Region.
The Health Plan Service Area (89k)
The Health Plan geographic area covers a large portion of Eastern Ohio and Northern and Central West Virginia as shown on this map of the plan service area regions.
The Health Plan Product Matrix (208k)
Included in this document are screen shots of Health Plan and THP Insurance
Company Member I.D. Card Samples.
Provider Focus Newsletters (past & present)
1st
Quarter 2008 (1MB)
Preauthorization Guidelines (187k)
4th
Quarter 2007 (603k)
3rd
Quarter 2007 (321k)
2nd
Quarter 2007 (321k)
1st Quarter 2007 (388k)
4th
Quarter 2006 (291k)
3rd
Quarter 2006 (984k)
2nd
Quarter 2006 (1MB)
Standards of Practice & Guidelines
The guidelines below are updated every two years or with changes
and mailed to providers. Please call 1.800.624.6961, ext. 7659 or 740.695.7659 if you require another set of guidelines and we will mail them out to you. If
you have additional questions about the Disease Management Guidelines, you
can call 740.699.6110.
Guidelines for Preventative Health (577kb)
Management of High Blood Cholesterol
Management of Hypertension
Management of COPD
Management of Diabetes Mellitus
Management of Chronic Heart Failure (CHF)
NEW! Substance Abuse
Management of Depression
Treatment of Tobacco Use and Dependence
Colorectal Screening
Standards for Patient Records
Community Acquired Pneumonia
Standard for Access to Care and Services
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