Provider Documents & Forms

Members enrolled in our HMO and POS products are required to select a Primary Care Physician (PCP) who acts as the coordinator of care for the patient. Members must contact their PCP prior to making appointments with specialty providers. Upon assessment of the patient needs, the PCP may find it appropriate to refer the patient to other participating specialty providers.

The Health Plan contracts with providers in order to obtain quality care at an affordable price. This enables us to contain premium increases to our membership. All services that can be properly performed by Health Plan providers must be referred in-plan. Services, which are not available through this in-plan network require preauthorization via an out-of-plan referral.

In addition to the Provider Manual and that training that accompanies it, The Health Plan Customer Service Represenatives are always available to assist in any way possible by calling 1.800.624.6961/740.695.7901 in the Ohio Valley/Mountaineer Region and 1.888.830.4370/740.330.4370 in the HomeTown Region. Listed below are links to help you access other helpful resources and documents.

In order to view some of these materials, you will have to have a copy of Adobe Acrobat Reader installed on your computer. If you do not, you can download and install the latest Acrobat Reader software free. Download Adobe Reader.

Documents can be ordered by Name (Alpha Ascending or Descending), Date Added or Number of Hits that the document has received to make it easier to find the document you want to download. Simply click on "Order By" Name, Date or Hits and "Ascendant" or "Descendent" and they will automatically repopulate accordingly.

 PROVIDER UPDATE FORM 

Users will need to have the most recent version of Adobe Acrobat or Adobe Reader (7.0 or greater). Users can fill out the following form ONLINE by clicking through the fields or "tabbing". Once the information is properly filled out, users then will click "Submit by Email". (Please note: if a field is required, the form will ask you to fill in the required pieces before sending it or it will not be delivered). Users without the most recent verison of Adobe Acrobat or Reader, can scroll to the bottom of the form and click "Print Form". The form will be printed for the user to manually fill out and return to The Health Plan Provider Relations either by mail or fax.