Changing the way you
receive healthcare

  • For Providers

    If you need to check enrollee eligibility, assistance with a referral, submit an authorization, report a hospitalization, check status of an authorization or a claim, or want the claims submission address, see the directory of departments.

    PHP (HMO SNP) is the first health plan in the United States that is designed exclusively for Medicare beneficiaries who are living with HIV. The plan is an exclusive chronic disease “Special Needs Plan” and includes a prescription drug benefit. PHP only serves Medicare beneficiaries who are HIV-positive is approved by the Centers for Medicare and Medicaid Services to operate in Los Angeles County, California and Broward and Miami-Dade Counties, Florida.

    AAAHC icon

    Although PHP is new in Georgia for 2018, the plan in California and Florida is accredited by the Accreditation Association for Ambulatory Health Care, Inc. (AAAHC). AAAHC is private, non-profit organization that develops standards to advance and promote patient safety, quality care, and value for health care through peer-based accreditation processes, education, and research. (By clicking on the above link, you will be taken to a website operated by AAAHC and not PHP.)

    PHP stresses prevention and education, promotes positive lifestyle changes, improves medical self-management, and increases patient and family satisfaction. The plan strives to improve the well being of patients by providing a medical home with providers who are experts in delivering care to people who are HIV-positive.

    The plan offers unique provider and member benefits and services:

    • Enhanced reimbursement fee structure
    • Expedited initial consultation process
    • Utilization management panel comprised of HIV-experienced nurses, pharmacists and physicians who actively practice HIV/AIDS medicine
    • Provider access to patient-level information
    • Adherence evaluations and collaborative planning with medical case managers
    • Affiliation with AIDS Healthcare Foundation, the world’s largest specialized provider of HIV/AIDS medical care systems
    • RN case managers to assist the physicians and patient with coordination of treatment plans, consultations, and medication adherence
    • Access to ACCME accredited continuing education at reduced or no cost to the provider
    • Specialty physician consultant network based on expert HIV primary care physician recommendations and HIV experience within their subspecialty
    • Invitation to actively participate in the plan’s quality improvement committees, e.g., pharmacy and therapeutics, standards and protocols, and credentialing committees

    And because PHP is from AIDS Healthcare Foundation, the plan is backed by the world’s largest HIV/AIDS health system operator.

    For more information about, or to request an application to join the plan’s provider network, please contact Provider Relations.