Message to CHP Providers from Linda Bahrke
You will soon receive formal notification that the board of directors of Heartland Health and Community Health Plan (CHP) have voted to exit the insurance market. Because the Department of Insurance regulations require three days notice before we are allowed to discuss this decision openly, I was unable to give you advanced word.
The solution agreed to by the boards was for CHP to exit the insurance market but continue to provide products that encouraged our community focus on health improvement, with the ultimate goal of reducing health-care costs for individuals who live in our service area. We are able to accomplish this goal by working with a national insurer to provide insurance coverage in our market, while continuing to provide our local, high-touch model of wellness and care management.
To that end, after much due diligence by both parties, it was determined that Aetna, Inc. has a philosophy that most closely mirrors that of Heartland Health's. Aetna strongly believes in the value of health improvement and working closely with providers to best manage members' care. Aetna sees the value of Community Health Plan's high touch approach to wellness. Both Heartland Health and Aetna are committed to providing a unique product that pairs our strengths.
Effective, July 1, 2009, Community Health Improvement Solutions (CHIS) will be a general agent for Aetna, selling their insurance products along with our wellness program.
What does this mean for you?
- You will be working with one of the nation's preferred partners for hospitals and physicians.
- Community Health Plan will continue to pay claims and honor your existing contracts.
- Aetna's regional medical director, Marla Tobin, MD, has offered to meet with any physician/physician group that would like to meet with her. She will be glad to discuss Aetna's approach to utilization and care management. I have found her to be patient centric and very interested in a good working relationship with providers.
- Aetna has committed to being a part of our community and working closely with Heartland Health to promote health improvement and quality service.
James McMillen, MD, FACP, Dr. Tobin and I will be glad to meet with any of you personally to further explain this change. If you wish to meet with any of us or have suggestions on how to further communicate this change to your peers, please contact my assistant, Debby Hanlan at (816) 271-1236.
Prior Authorization Lists
HMO - Prior Authorization List
PPO/Individual - Prior Authorization List
CHP Fast Facts is an informative quick reference for providers!
To access the HMO and PPO Provider Reference Manuals, please click on the link listed above or select it from the Provider dropdown menu in the top navigation.
Provider Credentialing Plan
Preventive Health Guidelines
Providers with questions may contact a Community Health Plan Customer Service Representative at (816) 271-1247 (option 2) or (800) 990-9247 (option 2).
As part of our pharmacy program, Community Health Plan has a pharmacy program coordinator available to you for any questions you may have regarding pharmacy benefits, utilization or costs.
Pharmacy Program Coordinator
(816) 271-4019
(800) 990-9247 (option 1) ext. 4019 (option 1) |
Provider claims may be sent to:
Community Health Plan
Heartland Health Business Plaza
137 N. Belt Hwy.
St. Joseph, MO 64506
HIPAA Companion Guides
Community Health Plan’s HIPAA Companion Guides are your tool for staying HIPAA compliant with your electronic transactions.
HIPAA Contingency Plan
270/271— Eligibility
276/277 — Healthcare Claims Status
820 — Payroll Deduction and Group Premium Payments
834 — Enrollment and Disenrollment
837 — Healthcare Claims (Institutional and Professional)
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