media

Providers

If you believe health plans should be collaborative, flexible and member-focused without being prescriptive—we want to partner with you. We seek providers with a track record of improving quality and lowering the cost of care. We support our providers with transparent, integrated network and plan benefits, along with data, reporting, and risk-management capabilities that allow providers to make outcomes-based decisions, so they can change their care models based on the local population’s needs.

From a Provider Support Team to a web-based Resource Center to a secure Provider Portal, we’re here to help support your patients and our members with their own Member Support Team, a web-based Member Resource Center, and a Member Portal, so you can focus on patient care.



media

Health Plan Provider Portal

www.HCHHealthPlan.com/members


Provider Support:

For plan numbers that start with "HH" , call 800.397.9524

For plan numbers that start with "HP" , call 844.486.8229


Driving value-based care

Unique to Healthcare Highways is our solution for increasing providers’ effciency and high quality outcomes and rewarding providers as our members get healthier, which reduces the total cost of care. Providers participate in bonuses for both practice efficiencies and quality outcomes:

Efficiency: Providers who manage their patients’ health with quality care at a lower aggregate cost than the market average (after risk adjusting for health differences) receive an annual financial bonus for each panel member.

Quality: Ten key metrics, ranging from immunization compliance to cancer screenings to controlling diabetic and hypertension scores are also considered when determining the bonus amount.


The power of provider networks

High-value networks are an essential component of Healthcare Highways’ effort to reduce healthcare costs. But to be successful with the clients and members we serve, we must work with healthcare systems and participating providers to create value through demonstrated quality and service at a reduced cost.

In a Healthcare Highways partnership, providers lead the effort to keep healthcare local, so they can change their care models based on the local population’s needs. Through increased coordination and transparency, Healthcare Highways offers integrated network and plan benefits, along with data, reporting, and risk-management capabilities that allow providers to make outcomes-based decisions.


Join our network

We take great pride in our network of hospitals, physicians, and other medical professionals who serve our members with the highest level of quality care and service.

We’re always looking for hospitals and physicians who are interested in a value-based care contract that combines the practice of coordinated healthcare, directed engagement of members, and reimbursement models for physicians that are based on practice efficiencies and quality outcomes.

Let’s talk about what makes your practice unique, and how we might be partners on this new pathway to affordable and quality healthcare.


Yes, I’d like to speak to Healthcare Highways about joining your network.

MOST CONVENIENT WAY TO REACH ME IS...


media

Verifying member eligibility

Providers are responsible for verifying member coverage and benefits prior to rendering any non-emergency services or treatments, we have made it easy for you to identify our members. Providers can confirm a member’s eligibility by calling the number for the health plan:

For Group Numbers that start with “HH” (in Oklahoma and Texas), call 866.353.8162

For group numbers that start with “HH” (in Louisiana), call 866.547.4255

For group numbers that start with “HP” (in all states), call 844-808-1247

All Healthcare Highways, Health Plan and Pharmacy members receive a Member ID card.

media

Appeals process

If you have questions about a claim, or need help with claim processing, we’re here to help. Calling Service Operations ( 888-806-3400 ) is the quickest way to have claims questions answered. Our Service Operations team member may escalate your question if we unable to answer your question during your call. (A reply may take up to five (5) business days.)

Use the written Provider Inquiry Process if a claim remains unresolved to your satisfaction. You have 180 days from the date you received the explanation of payment (or per your provider agreement) to write us. We’ll review and respond to you within thirty (30) days.

For more details and mailing instructions, please refer to your Provider Handbook.

media

Sample ID Card


Provider resources

We hope you’ll take advantage of these resources to stay informed and maximize the opportunity that our partnership provides you, Healthcare Highways, and our members. If you find something missing that you think would be helpful, please let us know.

media
media media media

INFORMATION SOURCE HCH HEALTH PLAN PARTICIPANTS NETWORK ACCESS PLAN ONLY PARTICIPANTS

Online Eligibility and
Benefits

www.HCHHealthPlan.com

Requires a brief initial registration process

Refer to the participant’s ID card

List of Network
Providers

www.HCHHealthPlan.com/provider-search

Refer to the participant’s ID card or in
Texas visit:
www.healthcarehighways.com/provider-search

Claims and Eligibility
Inquiries

800.397.9524

Refer to the participant’s ID card

Customer Service

888.806.3400

Refer to the participant’s ID card

Medical Management
and Precertification

866.353.8162
614.818.3236
(fax)
Online Intake: www.hchhealthplan.getprecert.com

Refer to the participant’s ID card

Electronic Claim Filing
Payor ID

HCH01

Refer to the participant’s ID card

Claims Address

Healthcare Highways Health Plan
PO Box 16817
Lubbock, TX 79490-6817

Refer to the participant’s ID card

Provider Demographic
Updates

www.hch.operations@healthcarehighways.com
Fax: 214.390.2139

Healthcare Highways Health Plan
Attn: Network Operations
6300 Fallwater Trail
Suite 120
The Colony, TX 75056

Same as Health Plan

Pharmacy Information

CerpassRx will be the PBM for many accounts. The pharmacy benefit manager will be identified on the front of the ID card.

Refer to the participant’s ID card

media

We’re here to help

Provider Claims Processing

If you have questions about a claim, or need help with claim processing, there are three ways that we support you. Calling Service Operations - 888-806-3400 is the quickest way to have your claims questions answered.

Provider Service Team

The Service Operations team member may escalate your question to this team, if we aren’t able to answer your question at the time you call. A reply may take up to five (5) business days.

Provider Claims Inquiry Process

Use this written process if a claim remains unresolved to your satisfaction. You have 180 days from the date you received the explanation of payment (or per your provider agreement) to write us. We’ll review and respond to you within thirty (30) days.

Contact us today

YOUR INFORMATION

*DO YOU OR ARE YOU LOOKING TO WORK WITH...