Provider Relations
(408) 885-2221
The Provider Relations Department is the primary point of contact for all providers. Its goal is to serve as a resource to all providers seeking information about network operations, credentialing providers, contracts interpretation and payment schedules. Section 12: group and individual training sessions on the following topics: The staff conducts
Provider Education Provider Disputes Access to Services Authorizations and Referrals Valley Express Legislative changes
Effective communication with providers is essential to improving overall satisfaction and services for our Members. Providers are encouraged to contact the Provider Relations Department with questions on policies, procedures, unresolved claims and general inquiries as well as to file any type of complaint or grievance. Providers may contact the Provider Relations Department during business hours at: (408) 885-2221. Please visit our website at www.valleyhealthplan.org to view the current version of the Drug Formulary, Clinical Practice & Referral Guidelines and Provider Manual, Updates and Bulletin’s. Notification Requirements To help Valley Health Plan maintain its directories, claims and payments records, it is important to notify the Provider Relations Department of any changes to your practice. Please notify the VHP in writing whenever a change in any of the following occurs: • • • • • • • • • • •
Name Change Billing address or practice location change Addition or deletion of clinic site New physicians or mid-level practitioners added or terminated from current practice Board certification or eligibility status change Privileges and licensure status Hospital affiliation Change in Tax Identification Number Professional malpractice or premise liability insurance changes Languages spoken in practice/Office hours Termination from employment
Provider Disputes Process VHP is committed to ensuring that its providers and members can resolve issues through its grievance and appeals process. VHP does not discriminate against providers or members for filing a grievance or an appeal. Providers are prohibited from penalizing a member in any way for filing a grievance. Furthermore, VHP monitors its grievance and appeals process as part of its quality improvement program and is committed to resolving issues within establish timeframes and referring specific cases for peer review when needed. www.valleyhealthplan.org rev.2020
Section 12
Page 39 of 68
SECTION 12: PROVIDER RELATIONS
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