Welcome to the HealthMed Services Provider Portal

HealthMed Services, Inc.

HealthMed Services, Inc. (HMS) is the Managed Care Services Organization (MSO) for PIH Health Physicians (PHP) and Pioneer Provider Network (PPN).

HMS is responsible for managing authorizations, capitation, claims, contracting, credentialing, eligibility, member services, provider relations and quality management.

Provider offices may use this portal for verifying authorizations, checking on claims status, quality-risk adjustment education material, auto approval Guideline forms, MSO Contact list, Provider Rosters, Provider Manual and any other information pertaining to PHP and PPN.

If you need to verify eligibility, please use the links below.  They will take you directly to each of the health plan websites:


Affirmation Statement


UM decision making is based on appropriateness of care and service and existence of coverage. The provider organization does not specifically reward practitioners or individuals for issuing denials of coverage, does not offer incentives to encourage denials, and does not encourage decisions that results in under-utilization. 


The provider organization ensures independence and impartiality in making referral decisions that will not influence hiring, compensation, termination, promotion and other similar matters.



COVID-19 UM Update


PHP/PPN will waive/reduce cost-sharing (including, but not limited to co-pays, deductibles or coinsurance) to zero for all medically necessary screening and testing for COVID-19, including hospital (including ER), Urgent Care visits, and provider office visits for the purpose of screening and/or testing for COVID-19.

 
 
 


   

Health Plan Eligibility Links - PHP


Commercial                                        Point of Service

Aetna (PHP)                                               Aetna (PHP)

Anthem Blue Cross (PHP)                        Anthem Blue Cross (PHP)

Blue Shield (PHP)                                       Blue Shield (PHP) 

Health Net (PHP)                                       Health Net (PHP)

United Healthcare (PHP)                          United Healthcare (PHP)


Medicare                                                    Medi-Cal 

Alignment (PHP)                                          Health Net (PHP)

Blue Shield Promise (PHP)                                                                                

Blue Shield 65 Plus (PHP)                         Admitting Hospitals - PHP

Health Net Seniority (PHP)                       PIH Health Hospital – Whittier

Humana (PHP)                                            PIH Health Hospital - Downey

SCAN (PHP)

United Healthcare (PHP)



Health Plan Eligibility Links – PPN


Commercial                                             Point of Service

Aetna (PHP)                                               Aetna (PHP)

Anthem Blue Cross (PPN)                       Anthem Blue Cross (PPN)

Blue Shield (PPN)                                     Blue Shield (PPN)

Health Net (PPN)                                      Anthem Blue Cross Sr (PPN)                      

United Healthcare (PPN)                        

                                                                   Medicare

                                                                    Aetna Sr (PPN)

                                                                    Alignment (PPN)      

Medi-Cal                                                    Anthem Blue Cross Sr (PPN)

Health Net (PPN)                                      Blue Shield (PPN)

L.A. Care (PPN)                                         Health Net (PPN)

                                                                    L.A. Care (PPN)

                                                                    SCAN (PPN)

Admitting Hospital – PPN                      United Healthcare (PPN)

PIH Health Hospital – Downey               Universal Care – Brand New Day (PPN)




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