Health Plan Data Reporting Update:
Partners For Kids is receiving capitation, eligibility, and medical claims data from both AmeriHealth and Humana. The Partners For Kids data team is working closely with both health plans to ensure the accuracy of the Partners For Kids population and key fields contained on the files. Neither health plan is currently included in official reporting. As we receive clarity on timelines for the file adjustments by the health plans, we will share them here.
Provider Loading Update:
During contract negotiations, a roster of all Partners For Kids credentialed providers was shared with Humana Healthy Horizons and AmeriHealth Caritas. Any providers that opted out of one or both of these agreements were shared with the appropriate managed care plan shortly after Partners For Kids received the request to opt out. Both plans are in the process of terming the providers that opted out. Unfortunately, the plans may have assigned members to providers that have opted out prior to processing the termination, so practices may see patients coming in that belong to a managed care plan they have opted out of. Partners For Kids is in regular communication with each plan to ensure that these opt outs are processed quickly to minimize disruption to both practices and patients that are seeking care. In the meantime, we recommend that practices continue to screen for patient health plan at the time an appointment is scheduled and when the patient arrives for their appointment to minimize situations where non-covered patients are seen.