Provider Files & Forms

For users with Adobe Acrobat/Reader 7.0 or greater.

The Health Plan has devised a form that will provide emergency response personnel and various physicians who may care for the member in event of a hospitalization, with a quick, at-a-glance medical history. Additional information that is important in caring for patients is also included. Emergency response personnel have supported us in the need for this information to be available. We have encouraged our members to complete an EMI form and keep it a location of their choice in their homes.

The Health Plan’s EMI is available to fill out online by clicking the link above as a .pdf download.

The availability of a free decal identifying that EMI is available in the home can be found at www.vialoflife.

We hope that you will assist your patients if they need help in completing this form. Please feel free to call the Quality Improvement Department at 800.624.6961, Ext. 7659 or 740.695.7659.

Use in conjunction with prior authorization form for Customized Equipment, Orthotics, and Prosthetics.

The purpose of this manual is to give you an overview of The Health Plan and its structure so that you can function more effectively as a provider.

In addition to this manual and the training that accompanies it, The Health Plan Customer Service Representatives are always available to assist in any way possible by calling 1.800.624.6961/740.695.7901 for the St. Clairsville Office and 1.888.830.4370/740.330.4370 for the Massillon Office.

Information pertaining to Credentialing/Recredentialing, Standards for Participation and Practitioner's Rights.

Form to be used in referring patient to The Health Plan's Smoking Cessation Program.

Listing of credentials required to become a Health Plan Provider.

Users with Adobe Acrobat or Adobe Reader 7.0 or greater will be able to fill out the following form below ONLINE by clicking on the fields or "tabbing" through the fields. 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 or it will not go through).

If users do not or cannot have the the lastest Adobe Acrobat or Adobe Reader, they can scroll to the bottom of the forms and click on "Print Form". The form will be printed for the user to then manually fill out and return to Health Plan Provider Relations either by mail or fax.

Included in this document are screen shots of Health Plan and THP Insurance Company Member I.D. Card Samples.

Informational materials used to assist and facilitate providers in various areas that have been identified by The Health Plan's Quality Improvement Department as opportunities for improvement.

The Health Plan geographic area covers a large portion of Eastern Ohio and Northern and Central West Virginia as shown on this map of the plan service area regions.