Important information regarding your Healthplex dental plan
For Providers
Become a Provider
The Uniformed Services Family Health Plan (USFHP) has provided comprehensive care for military families for over 30 years. Our mission is to continue giving our members first-class quality health care with the best possible providers available. If you are a provider who is interested in working with us, please reach out to us.
Check Your Claim Status and Information About Your Billing
In order to check your claim status, USFHP providers are asked to create an account on our Provider Portal.
Service Request Form
The Service Request Form is intended for providers to submit their patient’s authorization requests to Toney Healthcare for processing.
In order to request service, you will need to fill out the Service Request Form and submit it.
Authorization Management
Utilization management is a set of procedures used by or on behalf of our members related to their health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision. We at USFHP want to ensure that our members and providers have the best experience possible when attempting to obtain authorization for services.
Contact our authorization review department at (844) 356-4901 to pre-certify all services except outpatient Physical Therapy and Occupational Therapy.
Provider Manual
Download the PDF here.
Section 2 – Directory of Resources & Contacts
Section 5 – Covered Services-Out Patient
Section 8 – Primary Care Provider
Section 10 – Non-Covered Services Policy
Section 11 – Provider Credentialing Requirements
Section 13 – Network Disputes and Resolutions
Section 14 – US Family Health Compliance Program
Section 15 – Quality Management
Section 16 – Utilization Management Program
Section 17 – Pre-Authorization Process
Section 18 – In Patient Hospital Review
Section 19 – Case Management & Disease Management
Section 20 – Facilities Review (i.e. Skilled Nursing)
Section 21 – Ancillary Services
Section 22 – Pharmacy Services
Section 23 – Medial & Surgical Records Criteria
Section 24 – National Disaster Medical System (NDMS)
Section 25 – Certified Home Care Billing Guidelines
Provider Pulse Beat
Find the latest Provider Pulse Beat Here.
The Beat: A Quarterly Supplement to the Provider Pulse Beat
Find the latest The Beat Here
News and Updates
New Prior-Authorization Requirements for various J, Q and S Procedure Codes Effective 10/15/2023
Prior Authorization List for Drugs/Injectables
Behavioral Healthcare
Contact Magellan to pre-certify services or to obtain a listing of behavioral healthcare providers at (844) 356-4901. For more information on Magellan, visit their website at www.magellanassist.com.
For Providers
Mount Holly Surgical Supplies
Contact Mount Holly at (844) 356-4901 for most non-customized DME, ambulatory assistive devices, home oxygen, and home respiratory equipment.
LabCorp
All lab work should be referred to LabCorp with the exception of the in-office stat procedures. To obtain a listing of LabCorp Patient Service Centers, contact LabCorp at (800) 788-9091, or visit the LabCorp website at www.labcorp.com.
Physical Therapy / Occupational Therapy
To pre-certify outpatient Physical Therapy/Occupational Therapy services, contact OrthoNet at (844) 356-4901. For more information on OrthoNet, visit their website at www.orthonet-online.com.
Provider Quick Reference Guide
Download the PDF here.
Optum (Chiropractic/Acupuncture/Massage Therapy Providers)
Download the PDF here.
Health Education Material (with HEDIS + CAHPS) + other educational materials
VA/DoD Clinical Practice Guidelines
Download the PDF here.
CAHPS
Download the Powerpoint here.