About our providers

Partners Health Plan’s network of providers offers timely access to high quality care across the full continuum of covered services and supports.

Get the services and supports you need when you need them

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Quality and breadth of network

PHP has developed a comprehensive provider network that is diverse and responsive to the needs of the individuals that we serve, including offering our participants a choice of available providers across the full continuum of covered services under PHP Care Complete FIDA-IDD Plan. Our provider network has been specifically developed to include providers that are fully accessible to persons with disabilities and capable of delivering services in a culturally competent and sensitive manner. The network has sufficient breadth to offer our participants a choice of providers within the time and distance access standards established by the state and includes providers that are experienced in delivering care across the full range of IDD diagnoses, including individuals who are non-verbal, medically fragile, and/or exhibit challenging behaviors.

Our network also includes providers that treat patients in the AHRC/ARC’s affiliated clinics as well as providers of day habilitation programs, ICF/IID services, supervised and supportive residential alternatives, and vocational services, among others. We have also recruited local community providers (e.g., dentists and therapists) with expertise in serving persons with IDD.


Continuing with your current provider

If you are a newly enrolled participant that has been receiving treatment from an out-of-network provider for a service that is covered by PHP Care Complete FIDA-IDD Plan, you may continue to see your provider for at least 90 days following enrollment or until a comprehensive assessment has been completed (whichever is later) if all of the following criteria are met: 

  • You can demonstrate an existing relationship with the provider prior to enrollment (i.e., you visited the provider within the previous six months)

  • The provider is willing to accept payment based on the current Medicare/Medicaid fee schedule, as applicable

  • PHP would not otherwise exclude the provider from the network due to documented quality of care concerns

On an ongoing basis, PHP’s Provider Relations staff will make reasonable attempts (e.g., semi-annual telephone contacts, distribution of written materials about PHP, etc.) to recruit non-participating providers that have historically served PHP participants into our network.

Similarly, if you are a new PHP Care Complete FIDA-IDD Plan participant residing in an out-of-network Intermediate Care Facility, you will be allowed to remain in the facility as long as needed. PHP will also make a reasonable effort to recruit the facility into our network.


Your provider could join our network

PHP is always seeking to enhance our participants’ access to care from dedicated providers with experience in treating adults with IDD. If you and/or your authorized representative have been seeing or are familiar with a licensed provider of services and supports that would make a positive addition to PHP’s provider network, please let us know and our Provider Relations team will follow up. You can also ask the provider to contact us at 1-855-747-5483 or TTY/TDD: 711.


Categories of providers

PHP is dedicated to the development and ongoing maintenance of a comprehensive network of providers with the necessary qualifications and experience for delivering the full continuum of covered medical, behavioral, dental, and long-term supports and services (including pharmacies) to our participants. The following table lists the various types of providers in our network within each of three broad categories: medical, behavioral, and LTSS, including residential, habilitation, and other IDD-specific services. If you have a question about which services are covered under your program, please contact your care management team or Participant Services at 1-855-747-5483 or TTY/TDD: 711.

Medical/Physical Health Providers

Hospitals (inpatient and ambulatory)

Urgent Care Clinics

Clinic Services

Primary Care Physicians (i.e., Internal and Family Medicine, Gynecology)

Specialist Physicians (e.g., cardiology, ENT, endocrinology, nephrology, geriatrics, pulmonology, gastroenterology, neurology, urology, proctology, nephrology, etc.)

Dentists, Oral Surgeons, and Dental Hygienists

Nursing Services (RNs, NPs)

Home Health Care

Nutritional Services

Pharmacies

Laboratories

Radiological and Imaging Services

Renal Dialysis Providers

Rehabilitation Services

Occupational Therapists

Speech and Language Therapists

Physical Therapists

Vision Services

Durable Medical Equipment

Audiologists

Podiatrists

Skilled Nursing Facilities

Rehabilitation Facilities

 

Behavioral Health Providers

Psychiatric Hospitals (Inpatient and Ambulatory)

Psychiatrists

Licensed Nurse Practitioners

Certified Chemical Dependency Professionals

Psychologists

Licensed Independent Mental Health Practitioners

Licensed Behavioral Therapists

Licensed Clinical Social Workers with Psychotherapy Privilege

 

LTSS Providers, Including IDD-Specific Service Providers

Day and Community Habilitation Services

Residential Services (i.e., in OPWDD-certified residences)

Supported Employment Services

Transportation Services

Environmental Modifications

Personal Care

Family Care

Nursing Facilities

Pre-vocational Services

Intermediate Care Facilities for the Developmentally Disabled (ICF/IDDs)

Respite Care Services

 

 

 

 

 

GET HELP

Supporting the life you choose

Contact us at (855) PHP-LIVE  (747-5483) or TTY/TDD: 711

or
Visit the Online Help Center