Having developed or accumulated a substantial number

having developed or accumulated a substantial number of patients in the PA Health &
Wellness with high cost medical conditions
Coordinate and cooperate with other service providers who serve Medicaid Participants, such
as Head Start Programs, Healthy Start Programs, Nurse Family Partnerships, and school
based programs as appropriate
Object to providing relevant or medically necessary services on the basis of the provider’s
moral or religious beliefs or other similar grounds
Disclose to PA Health & Wellness, on an annual basis, any physician incentive plan (PIP) or
risk arrangements the provider or provider group may have with physicians either within its
group practice or other physicians not associated with the group practice even if there is no
substantial financial risk between PA Health & Wellness and the physician or physician group
Provide services in accordance with applicable state and federal laws and regulations and
adhere to the requirements set forth in the Participating Provider Agreement
Allow PA Health & Wellness direct access (not via vendor) to medical records for the purpose
of data collection initiatives, such as HEDIS and other contractual, regulatory or other
programs
Review and follow clinical practice guidelines distributed by PA Health & Wellness
Document Medical chart with up to three reach out attempts via phone to Participants
who have not completed an office visit in the past 12 month or more
Have been discharged from an inpatient-stay within the last 24 hours since notification
Have a gap-in-care overdue by 30 or more days
Develop report based on PA Health & Wellness specification to submit monthly clinical data
feed from the Electronic Medical Record (EMR) system within one year of enrolling in the PA
Health & Wellness Provider Network
Comply with Pennsylvania Risk Adjustment programs rely on complete and accurate
diagnosis coding and reporting according to the ICD-10-CM coding guidelines
Providers must allow for and process voluntary payroll deductions of fringe benefits or wage
supplements for any employee who requests it, in accordance with the Wage Payments and
Collection Law (43 P.S. §§ 260.2a and 260.3).

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Report all suspected physical and/or sexual abuse and neglect
Report Communicable Disease to PA Health & Wellness:
PA Health & Wellness must work with DOH State and District Office epidemiologists
in partnership with the designated county or municipal health department staffs to
appropriately report reportable conditions in accordance with 28 Pa. Code §§ 27.1
et seq.
It is your responsibility as a provider to participate in education on proper reporting of communicable
disease and reportable conditions. PA Health & Wellness has designated a single point of contact for
reportable conditions, who can be reached by calling 1-717-809-7035 or 1-866-535-2545 or by faxing to
1-844-873-7451. A copy of this policy can be found on our website, PAHealthWellness.com.