Social Services

Information for Providers

eHeath care providers can find information about Hillsborough County Health Care Plan (HCHCP) member eligibility, medical services covered by the plan, formulary information, referral and authorization requests, billing inquiries and information, a provider newsletter and links related clinical and educational sites.

Here, participating providers also can enroll prospective members online to facilitate patient care. The website also contains reference materials such as the provider guide and a quick reference formulary wall chart for providers. Information is available for the mandatory Patient Assistance Program.

  1. Billing Information

    Online Services

    The ASI provider website, where you can look up claims status and eligibility, is Hillsborough County’s current third-party claims administrator. ASI is wholly owned by American Benefits Plan Administrator (ABPA) and includes other plans as well, which is why you will see the ABPA home page.

    Obtaining a Login and Password

    • Obtain your login and password online
    • If you submit claims thorough an MSO, you will need to obtain access from your MSO
      • Your MSO must be or will need to be set up as account administrator
      • As the administrator they can give you access if you are contracted with them
    • If you submit claims directly to the ASI claims clearing house, Emdeon, or you are an MSO, you can obtain your own login
    To begin, you should select Provider Login. First time users will be prompted to register now. You will need to enter your Tax Identification Number (TIN), a member ID, and claim number.

    Additional Assistance

    MSOs, or other providers who need to be set up as the account administrator, should call Cyndi Wilson at (813) 666-6908
  2. Eligibility Verification Online Services
    There are two ways to determine whether a member is eligible for the Hillsborough County Health Plan:
    • Call (813) 272-5555
    • Visit the ASI provider website
      • ASI is Hillsborough County’s third-party claims administrator
      • ASI is wholly owned by American Benefits Plan Administrator (ABPA) and includes other plans as well, which is why you will see the ABPA home page

    Obtaining a Login and Password

    • Obtain your login and password online
    • If you submit claims thorough an MSO, you will need to obtain access from your MSO
      • Your MSO must be or will need to be set up as account administrator
      • As the administrator they can give you access if you are contracted with them
    • If you submit claims directly to the ASI claims clearing house, Emdeon, or you are an MSO, you can obtain your own login
    To begin, you should select Provider Login. First time users will be prompted to register now. You will need to enter your Tax Identification Number (TIN), a member ID, and claim number.

    Additional Assistance

    MSOs, or other providers who need to be set up as the account administrator, should call Cyndi Wilson at (813) 666-6908.
  3. Health Care Coverage Plans

    Once enrolled, members will receive a card that shows they qualify for Hillsborough Health Care and that they are a member. Members must bring the cards with them each time they see a caregiver.

    Types of Health Care Coverage by Plan Including Exceptions

    • Plan A
      • Members are covered for all necessary medical services, not including those services listed in the exceptions section of the manual
      • The patient’s primary care physician must coordinate all services for these plan members

    • Plan J
      • Members are covered for all Plan A services with the exception of inpatient facility charges
      • Plan J members are enrolled in the Medicaid Medically Needy program and must take their inpatient hospital bills to their Medicaid social worker

    • Plan D
      • Members require specific authorization from Hillsborough Health Care for each service authorized
      • Plan D members are covered for only a specific service

    Exception Codes

    Some patients have an exception code on their health care card. The codes are as follows:
    • XX: Patient has other coverage plan which may be primary payer, i.e. automobile insurance, etc.
    • YY: Patient has a specific illness or injury that is covered by another payer, i.e. worker's compensation, victims of crime compensation, vocational rehabilitation, etc.
    • MN: Patient has Medicaid Medically Needy program. Inpatient facility charges are not covered for payment as Medicaid is primary payer.

    Hillsborough Health Care is not a second-party payer for any service covered by another payer resource.

  4. Provider Guide: Updated Policies and Procedures Download or view the latest HCHCP Provider Guide.  
  5. Referrals/Pre-Authorizations  

    Visit KePRO, the Hillsborough County Health Care Plan’s utilization review and medical management vendor. In KePRO’s medical management system, you can enter referrals, request pre-authorizations and check on the status of existing referrals or pre-authorizations. If you are a first time user, you may need to register and set up an account.

    Provider Enrollment Database

  6. ACES Online Portal

    Use these guides to navigate the ACES online portal: