Welcome to thehealthplan.com for Providers!
Important Message affecting your Provider Service Center Access
As of September 18, 2014, Geisinger Health Plan will no longer support access to the Provider Service Center through www.thehealthplan.com. All Provider Service Center functionality and electronic transactions with GHP should be conducted through NaviNet, America's largest real-time health care communications network. If you are already using NaviNet, simply login at https://navinet.navimedix.com to access GHP information. If you are new to NaviNet, please visit https://connect.navinet.net/enroll to sign up.
See our requirements to participate in our network
This form allows our participating providers to update directory information, including but not limited to Primary Care Physician (PCP) acceptance status, address, phone, fax, locations and more.
Note: The effective date for provision of services by each new Participating Provider is contingent upon the approval by Geisinger Health Plan's Credentialing Committee.
Claims & E-transactions
Electronic Fund Transfer (EFT) and Electronic Explanation of Payment (835 Transaction)
In June 2016, GHP will replace paper check payments to providers with Claim Payment Cards. Claim Payment Cards are processed like any other credit/debit card payment you receive through the mail or by phone and are subject to existing merchant processing rates. To avoid receiving Claim Payment Cards, register for free EFT/ERA transactions from GHP.
To receive GHP payments directly deposited into your bank account and/or to begin receiving electronic remittance advice/835, please register at http://www.instamed.com/eraeft or complete the InstaMed Network Funding Agreement to be faxed or mailed to InstaMed.
If you have questions regarding registration, please contact InstaMed at (866) 945-7990 or email@example.com about this free solution.
EDI Claims Submission
Please use the GHP's Payer ID Number (75273) when submitting claims via AllScripts, Emdeon, or Relay Health. Please contact the following for more information:
To ensure efficient and timely reconsideration of claim payment/denial appeals, please utilize the Claims Research Request Form (CRRF) to initiate a reconsideration of a previously paid or denied claim. Please make copies of the blank form as necessary and retain a copy of the completed forms for your records or submit electronically via NaviNet.
- CRRF may be submitted electronically online through NaviNet
- Only submit one claim per CRRF form
- Include claim number and date of service
- Check the appropriate boxes (i.e. COB or Claim Edit)
- Health Plan has 45 days to review and process CRRFs
When to use a CRRF
- UA Denials (Failure to Precert Services) – Only when there is a compelling reason why the provider failed to precert, and the dispute is within timely filing guidelines.
- Claim Edit Denials – Be sure to check the claim edit box on the CRRF form and attach supporting documentation
- Timely Filing Denials – Only when there is a compelling reason for why the provider failed to submit timely.
- When information on a PAID CLAIM needs to be corrected (e.g., late charges, incorrect diagnosis, incorrect procedure code, incorrect revenue code, incorrect modifier, invalid Member ID, location code).
When NOT to use a CRRF
- Non-Participating Provider
- Claim Retractions – Providers should initiate through Customer Service on Secured Message via Web.
- When information on a DENIED CLAIM needs to be corrected. Providers should resubmit the corrected claim through their normal claims submission process.
- P2 or XX Denials – Questions related to provider contracts or fee schedules should be directed to your Provider Account Manager.
- Timely Filing Denials if no compelling reason exists. COB claims are not subject to timely filing.
- UA Denials – if no compelling reason exists.
Forms & Resources for Non-Participating Providers
- Outpatient Rehab Precert Form A (New Case)
- Outpatient Rehab Precert Form B (Updated Case)
- Outpatient Prior Authorization Request Form
- Formulary Exception/Prior Authorization Request Form
- Subutex®/Suboxone® Prior Authorization Request Form
- Vivitrol Prior Authorization Request Form
- Specialty Vendor Drug List/Request Form
- Hepatitis C Virus Protease Inhibitors Prior Authorization Request Form
- ≤ 17 Years Old Antipsychotic Authorization Request Form
- LA Atypical Antipsychotic Request Form
- Gold Nonpar Provider Appeal Process Form