Health plans and insurers

Jefferson Health Plans

Phone, published email, fax, addresses and the next step for your office.

22 contact routesNo directory research calls placed

prior authorization

Medical Management — utilization / prior authorization

Official page read

Phone866-500-4571Published hours

Not published in this record

Product, plan and location

Confirm the exact product or service
Pennsylvania · New Jersey

Mailing address

Not researched for this route

Menu guidance in the source record

Ancillary 2,2; Inpatient/Outpatient 2,3; Non-par 2,4; Peer-to-peer 2,1

Menus can change. No live call verification is claimed.

Prompts: ancillary (DME, home health) 2,2; inpatient/outpatient 2,3; non-par service requests 2,4; physician peer-to-peer 2,1. Authorization status via the provider portal.

View source ↗ · Source checked 2026-10-25

Report an update

Wait time: not establishedBest time from caller reports: not established. Published hours are not a wait forecast.

fax prior auth

Skilled nursing facility and rehabilitation authorizations

Official page read

Phone215-991-4395Fax

215-991-4125

Published hours

Not published in this record

Product, plan and location

medicare advantage · medicaid
Pennsylvania

Mailing address

Not researched for this route

SNF and rehab: Medicare phone 215-991-4395, Medicaid phone 267-385-3825; shared fax.

View source ↗ · Source checked 2026-10-25

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Wait time: not establishedBest time from caller reports: not established. Published hours are not a wait forecast.

pharmacy help desk

Pharmacy Department

Official page read

Phone866-841-7659Published hours

Not published in this record

Product, plan and location

Confirm the exact product or service
Pennsylvania

Mailing address

Not researched for this route

Pharmacy department; Recipient Restriction Program information 215-991-4094.

View source ↗ · Source checked 2026-10-25

Report an update

Wait time: not establishedBest time from caller reports: not established. Published hours are not a wait forecast.

pharmacy prior auth

Pharmacy prior authorization fax — Medicaid

Official page read

Phone

No phone listed for this route

Fax

866-240-3712

Published hours

Not published in this record

Product, plan and location

medicaid
Pennsylvania

Mailing address

Not researched for this route

Pharmacy prior authorization requests for Jefferson Health Plans EverWell (Medicaid).

View source ↗ · Source checked 2026-10-25

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pharmacy prior auth

Pharmacy prior authorization fax — Medicare Advantage

Official page read

Phone

No phone listed for this route

Fax

866-371-3239

Published hours

Not published in this record

Product, plan and location

medicare advantage · medicare part d
Pennsylvania · New Jersey

Mailing address

Not researched for this route

Pharmacy prior authorization requests for Medicare Advantage.

View source ↗ · Source checked 2026-10-25

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pharmacy prior auth

Pharmacy prior authorization fax — Individual and Family Plans

Official page read

Phone

No phone listed for this route

Fax

833-605-4407

Published hours

Not published in this record

Product, plan and location

exchange
Pennsylvania

Mailing address

Not researched for this route

Pharmacy prior authorization requests for Individual and Family (exchange) plans.

View source ↗ · Source checked 2026-10-25

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appeals grievances

Inpatient appeals email

Official page read

Phone

No phone listed for this route

Published email

Appeals@jeffersonhealthplans.com

Published hours

Not published in this record

Product, plan and location

Confirm the exact product or service
Pennsylvania

Mailing address

Not researched for this route

Inpatient appeals by email.

View source ↗ · Source checked 2026-10-25

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edi clearinghouse support

EDI support

Official page read

Phone

No phone listed for this route

Published email

EDI@jeffersonhealthplans.com

Published hours

Not published in this record

Product, plan and location

Confirm the exact product or service
Pennsylvania

Mailing address

Not researched for this route

Electronic data interchange support. ECHO Health EFT/ERA: 1-888-834-3511.

View source ↗ · Source checked 2026-10-25

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provider enrollment credentialing

Credentialing — status, correspondence and enrollment

Official page read

Phone

No phone listed for this route

Fax

215-967-4473

Published email

Credentialing@jeffersonhealthplans.com

Published hours

Not published in this record

Product, plan and location

Confirm the exact product or service
Pennsylvania

Mailing address

Not researched for this route

Credentialing status/correspondence/enrollment and site relocation/closure, NPI and PROMISe ID changes.

View source ↗ · Source checked 2026-10-25

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provider enrollment credentialing

Provider data management — credentialed provider linkages and demographic changes

Official page read

Phone

No phone listed for this route

Fax

267-515-6650

Published email

DataValidation@jeffersonhealthplans.com

Published hours

Not published in this record

Product, plan and location

Confirm the exact product or service
Pennsylvania

Mailing address

Not researched for this route

Linkages, terminations and demographic updates for credentialed providers.

View source ↗ · Source checked 2026-10-25

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provider enrollment credentialing

Provider data — hospital/facility-based and PT/OT/ST linkages

Official page read

Phone

No phone listed for this route

Fax

215-967-9274

Published email

ProviderData@jeffersonhealthplans.com

Published hours

Not published in this record

Product, plan and location

Confirm the exact product or service
Pennsylvania

Mailing address

Not researched for this route

Hospital/facility-based and therapy provider linkages, terminations and changes.

View source ↗ · Source checked 2026-10-25

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fax other

Quality — STARS/HEDIS medical records

Official page read

Phone855-218-2314Fax

215-967-9230

Published email

Hedis_records@jeffersonhealthplans.com

Published hours

Not published in this record

Product, plan and location

Confirm the exact product or service
Pennsylvania

Mailing address

Not researched for this route

STARS/HEDIS record submissions; care gap records use caregap_records@jeffersonhealthplans.com (same fax). Quality Management Department 1-855-218-2314.

View source ↗ · Source checked 2026-10-25

Report an update

Wait time: not establishedBest time from caller reports: not established. Published hours are not a wait forecast.

fax other

Quality of care / complaints

Official page read

Phone

No phone listed for this route

Fax

267-515-6648

Published email

quality@jeffersonhealthplans.com

Published hours

Not published in this record

Product, plan and location

Confirm the exact product or service
Pennsylvania

Mailing address

Not researched for this route

Quality of care concerns and complaints.

View source ↗ · Source checked 2026-10-25

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fax other

Audits

Official page read

Phone

No phone listed for this route

Fax

215-967-4477

Published email

audit@jeffersonhealthplans.com

Published hours

Not published in this record

Product, plan and location

Confirm the exact product or service
Pennsylvania

Mailing address

Not researched for this route

Audit correspondence.

View source ↗ · Source checked 2026-10-25

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case management

Clinical care management referrals

Official page read

Phone215-845-4797Published email

clinicalconnections@jeffersonhealthplans.com

Published hours

Not published in this record

Product, plan and location

Confirm the exact product or service
Pennsylvania

Mailing address

Not researched for this route

Refer patients for clinical care management.

View source ↗ · Source checked 2026-10-25

Report an update

Wait time: not establishedBest time from caller reports: not established. Published hours are not a wait forecast.

provider enrollment credentialing

Contracting

Official page read

Phone

No phone listed for this route

Published email

contracting@jeffersonhealthplans.com

Published hours

Not published in this record

Product, plan and location

Confirm the exact product or service
Pennsylvania

Mailing address

Not researched for this route

Initial contracts, group/practice ownership changes and Tax ID changes.

View source ↗ · Source checked 2026-10-25

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claims

Paper claims — Medicaid, CHIP, Medicare HMO/D-SNP and Individual/Family Plans

Official page read

Phone

No phone listed for this route

Published hours

Not published in this record

Product, plan and location

Confirm the exact product or service
Pennsylvania · New Jersey

Mailing address

Jefferson Health Plans PO Box 21228 Tampa, FL 33622

Paper claims (Payor ID 80142 products)

Payor ID 80142 for EverWell (Medicaid), CHIP, Medicare HMO/D-SNP (PA and NJ) and Individual and Family Plans. Medicare PPO uses separate boxes: PA PPO (Payor ID RP099) PO Box 21247; NJ PPO (Payor ID NJ099) PO Box 21367, Tampa, FL 33622.

View source ↗ · Source checked 2026-10-25

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prior authorization

eviCore — radiology, cardiology and MSK

Official page read

Phone888-693-3211Published hours

Not published in this record

Product, plan and location

Confirm the exact product or service
Pennsylvania · New Jersey

Mailing address

Not researched for this route

eviCore prior authorization for radiology, cardiology and MSK (joint, spine, pain).

View source ↗ · Source checked 2026-10-25

Report an update

Wait time: not establishedBest time from caller reports: not established. Published hours are not a wait forecast.

prior authorization

eviCore — radiation oncology, medical oncology, therapies and chiropractic

Official page read

Phone888-444-6178Published hours

Not published in this record

Product, plan and location

Confirm the exact product or service
Pennsylvania · New Jersey

Mailing address

Not researched for this route

eviCore for radiation/medical oncology, PT/OT/speech and chiropractic.

View source ↗ · Source checked 2026-10-25

Report an update

Wait time: not establishedBest time from caller reports: not established. Published hours are not a wait forecast.

behavioral health

Optum Behavioral Health — CHIP, Medicare Advantage and Individual/Family Plans

Official page read

Phone877-614-0484Published hours

Monday – Friday, 8 a.m. to 8 p.m. ET

Product, plan and location

Confirm the exact product or service
Pennsylvania

Mailing address

Not researched for this route

Behavioral health for CHIP, Medicare Advantage and IFP members (EverWell Medicaid behavioral health is through the county BH-MCO).

View source ↗ · Source checked 2026-10-25

Report an update

Wait time: not establishedBest time from caller reports: not established. Published hours are not a wait forecast.

dental

Avesis dental

Official page read

Phone800-952-6674Published hours

Not published in this record

Product, plan and location

dental
Pennsylvania

Mailing address

Not researched for this route

Dental vendor.

View source ↗ · Source checked 2026-10-25

Report an update

Wait time: not establishedBest time from caller reports: not established. Published hours are not a wait forecast.

vision

Davis Vision

Official page read

Phone800-773-2847Published hours

Not published in this record

Product, plan and location

vision
Pennsylvania

Mailing address

Not researched for this route

Vision vendor.

View source ↗ · Source checked 2026-10-25

Report an update

Wait time: not establishedBest time from caller reports: not established. Published hours are not a wait forecast.

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Jefferson Health Plans

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