Case management

Complex case management program

Our complex case management program helps members who have special health care needs and medical conditions. If you have special health care needs, you can be part of our program. You don't need a doctor's referral and you can opt out at any time.

The complex case management program allows you to work with case managers. Case managers can be nurses or social workers. They work with both adults and children and help:

  • You learn about your health conditions
  • Work with your Primary Care Provider (PCP), agencies and other organizations to get you the services and care you need
  • With communication between the PCP, family and specialists
  • Assist you with applying for the Medical Assistance Transportation Program (MATP).
  • Get you special equipment and home health services if you need them.

We also support pregnant women with a special program to help them stay healthy during their pregnancy. There may be health incentive rewards for going to your prenatal and

post -partum check-ups. Ask your Case Manager. If you or your child has a special need, call Members Services at:

  • 1-866-638-1232, TTY PA Relay 7-1-1 (Medical Assistance)
  • 1-800-822-2447, TTY 1-800-628-3323 PA Relay: 711 (CHIP)
  • 1-855-346-5635, TTY PA Relay 7-1-1 (Private Coverage Option)


Early intervention for adults and children

PA CONNECT is a program that provides early intervention support and services for children who may have developmental delays. This program helps parents obtain services your child may need. PA CONNECT will work with your doctor to support your child's growth and development. For more information, call PA CONNECT at 1-800-692-7288.