No. Keystone First – CHIP is a separate health plan that will be administered by Keystone Family Health Plan.
Other health plans in the Keystone Family of Health Plans include:
July 1, 2025:
Keystone First – CHIP will provide all CHIP covered services currently covered by Keystone HMO CHIP, absent any benefit updates directed by DHS. Provided enrollees remain eligible for CHIP and have not otherwise disenrolled from Keystone HMO CHIP, they will be transitioned from Keystone HMO CHIP to Keystone First – CHIP with no lapse in coverage.
The CHIP program covers children and teens under the age of 19:
No. We are actively contracting with providers to incorporate the Keystone First – CHIP product as a part of your existing contract and will negotiate new provider contracts, as necessary. We aim to maintain as much network continuity as possible.
You can send contract questions to: chipinquiries@keystonefirstpa.com or to your current Provider Account Executive.
Yes. All participating providers are assigned a dedicated Provider Account Executive. If you are currently a participating medical provider with Keystone First, your current Provider Account Executive will continue to support your practice for Keystone First – CHIP.
Current Keystone Family Health Plan medical provider ID numbers will remain the same for Keystone First – CHIP plan.
All newly contracted and credentialed medical providers will be assigned a plan provider ID number.
You do not need to request a new prior authorization. All prior authorization service dates and units remaining on the authorization approved by (IBX) Keystone HMO CHIP will be transferred to Keystone First – CHIP.
Claims and/or resubmitted/corrected claims for dates of service for June 30, 2025 and prior must continue to be submitted and follow all guidelines and procedures outlined by (IBX) Keystone HMO CHIP. For example: Only submit your Keystone HMO CHIP provider number and/or the Keystone HMO CHIP member ID number.
For dates of service on and after July 1, 2025, claims will be submitted to Keystone First – CHIP.
More information regarding claim submission addresses, payer ID, etc. will be coming soon.
Any questions concerning claims for the dates of service June 30, 2025, and prior should be addressed through IBX contacts and not with Keystone First – CHIP contacts.
For dates of service on and after July 1, 2025, the claims status inquiry function in NaviNet will be utilized. Alternatively, you can call Keystone First – CHIP Provider Services at 1-800-521-6007.
No. The current CHIP benefits offered through Keystone HMO CHIP will not change as a result of this transition, absent any benefit updates directed by DHS. Provided enrollees remain eligible for CHIP and have not otherwise disenrolled from Keystone HMO CHIP, enrollees will be transitioned from Keystone HMO CHIP to Keystone First – CHIP with no lapse in coverage.
Yes. All current Keystone HMO CHIP enrollees will receive new ID cards from Keystone First – CHIP.
Effective July 1, 2025, enrollee eligibility verification, claims status inquiry, and prior authorization submission and inquiry capabilities will be accessed through NaviNet.
Existing Keystone First plan(s) registered provider offices will have Keystone First – CHIP automatically added to their access/account without having to proactively register.
If you do not have access to the NaviNet provider portal, please sign up for NaviNet by July 1, 2025.
