Welcome providers. Let’s get your questions answered.

A QHP is a plan that meets certain requirements under the Patient Protection and Affordable Care Act (ACA). A QHP is certified by the Centers for Medicare & Medicaid Services (CMS). Many QHPs have networks that are unique to these plans. Often, these networks have a smaller number of participating providers compared to our traditional networks.

Member ID cards will have “QHP” on the top right of the card. The product name and the plan name are on the right side of the card. There is a dedicated member services toll-free number.

These plans will have an effective date of January 1, 2023 if a member enrolls and makes first binder payment by December 15, 2022. If a member enrolls and makes first binder payment between December 16, 2022 and January 15, 2023, their plans will be effective as of February 1, 2023.

Open Enrollment starts November 1, 2022 and ends January 15, 2023.

Yes, the payer ID and claim address are the same for exchange plans and are provided below:

Medical Providers in Virginia
Innovation Health
PO Box 981106
El Paso, TX 79998-1106

Innovation Health providers can check their status here: https://www.myplanportal.com/dsepublic/#/contentPage?page=providerSearchLanding&site_id=innovationhealthivlexchange

If you are registered with our Availity Provider portal, you can perform most electronic transactions in the portal, including submitting claims, checking claim status and patient benefits and eligibility, requesting pre-certifications, and submitting disputes and appeals. 

You will verify benefits or eligibility in the same way regardless of where the member purchased the plan. If you are registered with our Availity Provider portal, you can perform most electronic transactions in the portal, including submitting claims, checking claim status and patient benefits and eligibility, requesting pre-certifications, and submitting disputes and appeals.  

Yes, use our provider search online referral directory (links located below) to find providers in the exchange network. Remember, members have no out-of-network benefits on any plan except for emergencies.

Innovation Health Providers: https://www.myplanportal.com/dsepublic/#/contentPage?page=providerSearchLanding&site_id=innovationhealthivlexchange

No, the existing claims filing limits will apply.

The ID number listed on the member ID card (the one ending in “00”) is the member ID for the subscriber. When submitting inquiries or other requests (such as a claim or prior authorization request) for someone other than the subscriber, replace the “00” with the last two numbers that pertain to that other person. Example:

Subscriber (Joseph Smith) = 320004841700

Dependent 1 (Jane Smith) = 320004841701

Dependent 2 (Daniel Smith) = 320004841702

Most Innovation Health individual and family insurance plan members will be auto-assigned a PCP. If they contact customer service, the selection can be made at that time, and then we will mail them a new ID card. Members updating their PCP will not have the selection go into effect until the 1st of the subsequent month.

There are no out of network benefits on any Innovation Health individual and family insurance plan except for emergencies. If Innovation Health approves something, it would be at the in-network benefit and at a contracted rate (if broad network provider), or LOA negotiated. MinuteClinic^® locations and some labs have a national network, so they are not considered out of network if they are outside of the service area.

Northern Virginia (Innovation Health)

2022 Formulary Information

2023 Formulary Information - Coming soon!

Claims will continue to be paid for any claims that occur during the first month of non-payment. 

The grace period is different between members who receive premium subsidies (Advance Premium Tax Credit) and those who don’t:

• For members who receive premium subsidies, there is a 90-day grace period. At the start of the second month of non-payment, claims will be pended until payment is received in full.  If the member doesn’t pay, their termination date will be the last day of the first month (they get the first month free) and any claims paid after the termination date would be an overpayment
• For members who don’t receive premium subsidies, the grace period requirements vary between 30-31 days.  If the member doesn’t pay, their termination date will be the last day of the prior month that the premium was paid, and any claims paid after the termination date would be an overpayment

We'll process the claim in accordance with the plan benefits. If the member has assigned benefits, Innovation Health will pay you directly. Members have no out-of-network benefits on any plan in any state except for emergencies.

Innovation Health will provide reimbursement as outlined in your current contract. Refer to your contract agreement/amendment for details.