Community Health Partnership - A Program of Partnership Health Plan, Inc. Providers
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PROVIDER MANUAL

The PHP Provider Manual is developed as a tool for Plan Providers to use when they provide care and treatment to PHP Members. It defines policies, procedures and guidelines required by the Centers for Medicare and Medicaid Services (CMS), the State of Wisconsin Department of Health and Family Services (DHFS) and PHP.

The manual is divided into sections according to general topics. The manual will continue to change and evolve as PHP grows and will be updated on an as-needed basis.

It's recommended you refer to our website for the most current, electronic document of the Provider Directory and Provider Manual. Hard copies of the PHP Provider Directory and Provider Manual can be obtained by calling the Provider Relations Department at 715-858-7820. PHP cannot guarantee continued affiliation with any provider that is listed in the Directory.

Table of Contents
Section 1 Introduction
Section 2 Partnership Health Plan, Inc. Responsibilities
Section 3 Covered Services
Benefits Chart
Section 4 Non-Covered Services
Section 5 Care Management
Section 6 Member Rights
Section 7 Member Appeals
Section 8 Member Responsibilities
Section 9 How to Identify Member Coverage
Section 10 Provider Billing and Reporting
Section 11 Coordination of Benefits
Section 12 Provider Appeals
Section 13 Provider Selection
Section 14 Access Standards
Section 15 Expectations of All Plan Providers
Section 16 Credentialing
Section 17 Provider Termination
Section 18 Protocol for Assessing the Quality of a Plan Provider
Section 19 Utilization Management
Section 20 Quality Improvement Program
Glossary
Appendix 1 Member Request for Appeal or Grievance Form
Appendix 2 Provider Appeal Form
Appendix 3 Provider Credential Information Form
Appendix 4 Appointment of Representative Form
Appendix 5 Physician Request for Coverage Determination Form
Contact Information
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