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.
From a Provider Support Team, to a web-based resource center, to a secure Provider Portal, we’re here for you and your patients (866) 945-2292 8 AM to 5 PM, Monday through Friday, so you can focus on patient care.
Click here to check claims and claim status, eligibility, and review member benefits. Please access case management options by referring to the number on the back of the member’s ID card.
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.
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.
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.
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
All Healthcare Highways, Health Plan and Pharmacy members receive a Member ID card.
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.
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.
We are currently updating our provider form. To update your information, please click the “Update Your Info” link to the right. An excel spreadsheet will automatically begin to download. Please submit the completed excel spreadsheet to firstname.lastname@example.org.
We appreciate your patience. If you require assistance, please contact (866) 945-2292 Monday through Friday 8 AM to 5 PM, or email email@example.com, anytime.
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.
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.
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.