About the PHP Provider Network
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 all PHP Plans. 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 and clinic providers (e.g., physicians, 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 or PHP Care Preferred Medicaid 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.
How can we assist you?
Contact Partners Health Plan for current member assistance, to learn more about becoming a PHP member, or for general questions and inquiries.