Get the services and supports you need when you need them. Partners Health Plan’s network of providers offers timely access to high quality care across the full continuum of covered services and supports.


 

Quality and Breadth of Network

PHP has developed a comprehensive provider network that is diverse and responsive to the needs of the individuals that we serve, including offering our participants a choice of available providers across the full continuum of covered services under PHP Care Complete FIDA-IDD Plan. Our provider network has been specifically developed to include providers that are fully accessible to persons with disabilities and capable of delivering services in a culturally competent and sensitive manner. The network has sufficient breadth to offer our participants a choice of providers within the time and distance access standards established by the state and includes providers that are experienced in delivering care across the full range of IDD diagnoses, including individuals who are non-verbal, medically fragile, and/or exhibit challenging behaviors.

Our network also includes providers that treat patients in the AHRC/ARC’s affiliated clinics as well as providers of day habilitation programs, ICF/IID services, supervised and supportive residential alternatives, and vocational services, among others. We have also recruited local community providers (e.g., dentists and therapists) with expertise in serving persons with IDD.

 

Continuing with your current provider

If you are a newly enrolled participant that has been receiving treatment from an out-of-network provider for a service that is covered by PHP Care Complete FIDA-IDD Plan, you may continue to see your provider for at least 90 days following enrollment or until a comprehensive assessment has been completed (whichever is later) if all of the following criteria are met:

  • You can demonstrate an existing relationship with the provider prior to enrollment (i.e., you visited the provider within the previous six months)
  • The provider is willing to accept payment based on the current Medicare/Medicaid fee schedule, as applicable
  • PHP would not otherwise exclude the provider from the network due to documented quality of care concerns

On an ongoing basis, PHP’s Provider Relations staff will make reasonable attempts (e.g., semi-annual telephone contacts, distribution of written materials about PHP, etc.) to recruit non-participating providers that have historically served PHP participants into our network.

Similarly, if you are a new PHP Care Complete FIDA-IDD Plan participant residing in an out-of-network Intermediate Care Facility, you will be allowed to remain in the facility as long as needed. PHP will also make a reasonable effort to recruit the facility into our network.

 

Your provider could join our network

PHP is always seeking to enhance our participants’ access to care from dedicated providers with experience in treating adults with IDD. If you and/or your authorized representative have been seeing or are familiar with a licensed provider of services and supports that would make a positive addition to PHP’s provider network, please let us know and our Provider Relations team will follow up. You can also ask the provider to contact us at 1-855-747-5483 or TTY/TDD: 711.

 

Categories of providers

PHP is dedicated to the development and ongoing maintenance of a comprehensive network of providers with the necessary qualifications and experience for delivering the full continuum of covered medical, behavioral, dental, and long-term supports and services (including pharmacies) to our participants. The following table lists the various types of providers in our network within each of three broad categories: medical, behavioral, and LTSS, including residential, habilitation, and other IDD-specific services. If you have a question about which services are covered under your program, please contact your care management team or Participant Services at 1-855-747-5483 or TTY/TDD: 711.

 

Medical/Physical Health Providers
Hospitals (inpatient and ambulatory)Urgent Care ClinicsClinic Services
Primary Care Physicians (i.e., Internal and Family Medicine, Gynecology)Specialist Physicians (e.g., cardiology, ENT, endocrinology, nephrology, geriatrics, pulmonology, gastroenterology, neurology, urology, proctology, nephrology, etc.)Dentists, Oral Surgeons, and Dental Hygienists
Nursing Services (RNs, NPs)Home Health CareNutritional Services
PharmaciesLaboratoriesRadiological and Imaging Services
Renal Dialysis ProvidersRehabilitation ServicesOccupational Therapists
Speech and Language TherapistsPhysical TherapistsVision Services
Durable Medical EquipmentAudiologistsPodiatrists
Skilled Nursing FacilitiesRehabilitation Facilities

 

Behavioral Health Providers
Psychiartric Hospitals (Inpatient and Ambulatory)PsychiatristsLicensed Nurse Practitioners
Certified Chemical Dependency ProfessionalsPsychologistsLicensed Independent Mental Health Practitioners
Licensed Behavioral TherapistsLicensed Clinical Social Workers with Psychotherapy Privilege

 

LTSS Providers, Including IDD-Specific Service Providers
Day and Community Habilitation ServicesResidential Services (i.e., in OPWDD-certified residences)Supported Employment Services
Transportation ServicesEnvironmental ModificationsPersonal Care
Family CareNursing Facilities Prevocational Services
Intermediate Care Facilities for the Developmentally Disabled (ICF/IDDs)Respite Care Services