Providers

Change Healthcare System Interruption

Change Healthcare, our electronic data interchange (EDI) clearinghouse for claims and payment cycle management, continues to address their network interruption related to a security incident. Below are updates for our systems and processes:

  1. Claims payments: We have resumed payments for claims submitted prior to the incident. Since Change Healthcare is still unable to accept claims submissions, providers who submitted claims during the outage may be able to resubmit them either through additional solutions identified below through Availity, or once Change Healthcare's connectivity is restored, through Change Healthcare. We appreciate the inconvenience this is causing.
  2. Electronic claims submission: We have established a connection with Availity to receive electronic claims. If you or your clearinghouse do not currently use Availity to submit claims, you may register at: https://www.availity.com/Essentials-Portal-Registration. You will find registration options for Healthcare and Atypical Provider, so please choose the one that aligns with your business. For registration process assistance and other resources, access the https://www.availity.com/documents/learning/LP_AP_GetStarted/index.html#/ link on the Availity registration page.
  3. Electronic remittance advice: Electronic remittance are available at this time. However, some individual remittance advices may not be available due to Change Healthcare's security incident.
  4. Prior authorization submission and processing: The prior authorization systems continue to operate normally.
  5. Eligibility verification, claim status inquiry, and authorization inquiry: These capabilities continue to be available via NaviNet. If you do not have access to NaviNet provider portal, please visit https://register.navinet.net to sign up.

Please note, in the interim, our Provider Services Department will not be able to assist with processing of your payments any sooner. If you have other questions, you may contact Provider Services at 1-800-521-6007.

Thank you for your participation in our network and for your continued commitment to the care of our Members/Participants. We will continue to provide updates as we work to resolve the downstream impacts of Change Healthcare's service interruption.

As a Keystone First VIP Choice provider, you are a part of a dedicated network that is ready to meet our members' health care needs. As partners in care, we'll work with you to ensure that our members receive access to the quality health care they need and deserve, through a plan which features:

  • A coordinated care approach.
  • Leading technology solutions.
  • Innovative community outreach programs that offer better health outcomes to our members.

Our robust network is designed to provide our members with integrated care. You will find other committed providers like you in the directories below:

  • Find a provider
    Search for a PCP, specialist, hospital, or other health care provider in our network. Provider data contained within the online directory is updated daily Monday through Friday.
  • Pharmacy directory
    See a list of all of the pharmacies in our network.

If you notice any errors in the directory, please fax, on practice letterhead, the information as it should appear, to the attention of Provider Services at 1-800-521-6007.

Want to join our network?

We're always looking for providers to join our network of care, so if you are not yet a participating provider and would like information on joining our network, call 1-800-521-6007. You can also read the credentialing information for Keystone First VIP Choice.

Other quick resources:

We'll be offering even more provider-centric resources in the near future, including education webinars and local workshops. Look for updated provider materials and communications on this site, and if you have any additional questions, call Keystone First VIP Choice Provider Services at 1-800-521-6007, Monday through Friday, 8 a.m. – 8 p.m., from April 1 to September 30; or seven days a week, 8 a.m. – 8 p.m., from October 1 to March 31.

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