Yes! You can use AI to fill out Geisinger Health Plan Behavioral Health Professional Services Questionnaire
The Geisinger Health Plan Behavioral Health Professional Services Questionnaire is a provider information form that documents a practitioner’s demographics, accepted age groups, languages, specialties, therapies/treatments offered, and conditions they are willing to treat. Geisinger Health Plan uses the responses to help members and referring providers identify appropriate behavioral health services and connect patients to the right care quickly. It is important because accurate selections improve directory/referral accuracy and ensure members can find providers who match their clinical needs and service preferences (e.g., telehealth, MAT, testing, PHP/IOP).
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Form specifications
| Form name: | Geisinger Health Plan Behavioral Health Professional Services Questionnaire |
| Number of pages: | 5 |
| Language: | English |
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How to Fill Out GHP BH Services Questionnaire (HPM50) Online for Free in 2026
Are you looking to fill out a GHP BH SERVICES QUESTIONNAIRE (HPM50) form online quickly and accurately? Instafill.ai offers the #1 AI-powered PDF filling software of 2026, allowing you to complete your GHP BH SERVICES QUESTIONNAIRE (HPM50) form in just 37 seconds or less.
Follow these steps to fill out your GHP BH SERVICES QUESTIONNAIRE (HPM50) form online using Instafill.ai:
- 1 Enter provider and practice identifiers: provider name, credentials, NPI, address, county, group name, and listing phone number.
- 2 Select the age groups the provider accepts (children, adolescents, adults, geriatrics).
- 3 Select all languages the provider can use to communicate with patients (including ASL and any “Other” language).
- 4 Check any areas of specialization (e.g., eating disorders, autism spectrum disorders, chronic pain, PTSD/trauma, LGBTQ+ issues).
- 5 Check all services/therapies/treatments offered (e.g., CBT/DBT/EMDR, medication management, testing, telehealth, MAT, TMS/ECT/esketamine, IBHS/PIBHS).
- 6 Indicate which conditions the provider would treat if referred and complete the PHP/IOP section (if applicable) by population and program type.
- 7 Review for accuracy, sign and date the affirmation, and provide contact details (email, relationship to practice, fax number), then submit via fax (570-271-5297) or email ([email protected]).
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Frequently Asked Questions About Form GHP BH Services Questionnaire (HPM50)
This questionnaire helps Geisinger Health Plan members and referring providers find the right behavioral health services quickly. The information you provide is used to describe your services, specialties, and patient populations you accept.
Behavioral health practitioners and/or practices (including facilities) that want Geisinger Health Plan members and referring providers to understand what services they offer should complete it. Complete it as accurately as possible based on your scope of practice.
Yes—complete a questionnaire for each practitioner at your practice or for each facility location. If all practitioners or all locations provide the same services, you may submit one form for the whole group.
You can fax the completed form to 570-271-5297 or email it to [email protected]. Make sure the form is signed and dated before submitting.
You should provide the provider name, credentials (degree/license/designation), NPI, address, county, group name, and a listing phone number. This information helps Geisinger identify and list the provider correctly.
The listing phone number is the number Geisinger members and referring providers should call to reach you for services. Use the main scheduling or intake number whenever possible.
Check all age groups you accept in your practice: Children (≤12), Adolescents (13–17), Adults (18–64), and/or Geriatrics (≥65). Only select groups you are currently able and willing to see.
Check the languages you can communicate with patients in (e.g., American Sign Language, Spanish) and write in any additional languages under “Other.” Only select languages that are reliably available for patient communication in your practice.
“Specialize in” indicates areas where you have focused expertise or specialized services. “Would you treat if referred” indicates conditions you are willing to treat even if they are not a primary specialty.
Yes—check all services, therapies, and treatments you actually provide. The more complete the list, the easier it is for members to find a provider who offers the specific service they need.
Only check these services if your practitioner or location directly provides them. If you typically refer patients elsewhere for these treatments, leave them unchecked.
PHP (Partial Hospitalization Program) and IOP (Intensive Outpatient Program) are structured higher levels of care. If your group offers PHP and/or IOP, check the appropriate boxes by diagnosis type (ED, MH, SUD) and by age group.
Use the “Other:” line in the conditions section to write in additional conditions you treat. For items not listed elsewhere, include the closest applicable selections and provide the additional detail where the form allows.
The form should be signed by the person completing it who can attest the selections are accurate and within the practice’s scope (often the practitioner, practice manager, or authorized administrative staff). Include the date, email, relationship to the practice, and fax number.
The form does not list a specific processing timeframe. If you need confirmation or an update, contact Geisinger Health Plan using the submission email ([email protected]) and reference the provider name and NPI.
Compliance GHP BH Services Questionnaire (HPM50)
Validation Checks by Instafill.ai
1
Provider Name presence and legal-name format
Validates that the Provider name field is completed and contains a plausible full legal name (e.g., first and last name, not only initials or a single word). This is important for directory accuracy, credentialing alignment, and avoiding duplicate or ambiguous listings. If validation fails, the submission should be rejected or routed for manual review with a request to provide the full legal provider name.
2
Credentials (degree/license/designation) required and standardized
Checks that Credentials are provided and match an allowed set or pattern (e.g., MD, DO, PhD, PsyD, LCSW, LPC, LMFT, CRNP) and are not free-text placeholders like "N/A" when a credential is required. Standardizing credentials improves search/filtering and reduces misrepresentation risk. If invalid, the form should prompt the submitter to select/enter a recognized credential or be flagged for verification.
3
Provider NPI format and checksum validation
Ensures the Provider NPI is present and is exactly 10 digits, numeric-only, and passes the NPI Luhn check-digit algorithm. This prevents directory mismatches and downstream claim/referral routing errors. If validation fails, block submission and request correction because an invalid NPI can break provider identification.
4
Address completeness and deliverability checks
Validates that Address includes required components (street, city, state, ZIP) and that ZIP is 5 digits (or ZIP+4 in a valid format). A complete address is necessary for member access, mapping, and network directory compliance. If incomplete or malformed, the submission should be rejected or returned for correction.
5
County required and consistent with address
Checks that County is provided and, when possible, is consistent with the submitted ZIP/city/state (e.g., via a ZIP-to-county reference). This supports accurate regional directory listings and referral routing. If the county is missing or inconsistent, flag for correction or manual review to prevent incorrect geographic placement.
6
Group Name required when applicable and not conflicting with provider name
Validates that Group Name is completed when the submission indicates a group practice (or when multiple practitioners are implied) and that it is not identical to the Provider name unless the provider is a sole proprietor. This reduces duplicate listings and clarifies whether services apply to an individual or a group. If validation fails, prompt the submitter to clarify the practice entity name.
7
Listing Phone Number format and plausibility
Ensures Listing Phone Number is present and matches a valid phone format (e.g., 10 digits for US numbers, allowing standard punctuation) and is not an obviously invalid value (e.g., all zeros). Accurate phone numbers are critical for member access and referral completion. If invalid, block submission and request a corrected phone number.
8
Fax number format validation (if provided/required)
Validates that Fax number, if provided (or required by workflow), matches a valid phone number format and is not identical to the listing phone unless explicitly allowed. This helps ensure documents can be transmitted successfully and reduces contact-channel confusion. If invalid, prompt correction; if missing but required, prevent submission.
9
Email address format and domain validation
Checks that Email is present and conforms to standard email syntax (local@domain) and does not contain spaces or invalid characters. Email is needed for follow-up, clarifications, and operational communication. If invalid or missing, the form should be rejected or routed for correction depending on whether email is mandatory.
10
Age groups selection required (at least one checked)
Ensures at least one age group is selected (Children, Adolescents, Adult, Geriatrics). This is essential for member matching and preventing inappropriate referrals. If none are selected, block submission and require the submitter to indicate the populations served.
11
Language selection integrity and 'Other' specification requirement
Validates that selected languages are from the provided list and, if 'Other' is selected, the 'Other' text field is completed with a specific language (not blank or generic like "various"). This improves accessibility matching and reduces misleading directory entries. If 'Other' is checked without a value, prompt for the missing language.
12
Specialization selection consistency with services offered
Checks for logical consistency between specializations and services (e.g., selecting Autism Spectrum Disorders specialization should typically align with offering ABA/EIBI/related behavioral services; selecting Addiction/Substance Use Disorders specialization should align with SUD-related services). This helps prevent inaccurate marketing and inappropriate referrals. If inconsistencies are detected, flag for review or prompt the submitter to confirm/correct selections.
13
Services/therapies selection required (at least one checked)
Ensures at least one service/therapy/treatment is selected from the services list. Without at least one service, the directory entry provides no actionable information for referrals. If none are selected, block submission and require the submitter to indicate offered services.
14
Condition willingness-to-treat selection required and 'Other' completion
Validates that at least one condition under 'If referred, would you treat any of the following?' is selected, and if 'Other' is selected, the 'Other' text is completed with a specific condition. This supports accurate referral matching and reduces inappropriate referrals. If missing, prompt for at least one condition or a clear 'Other' entry.
15
PHP/IOP grid completeness and internal consistency
If any PHP/IOP option is indicated, validates that selections are made in a consistent manner across disorder categories (ED/MH/SUD) and age rows, and that the grid does not contain ambiguous partial markings (e.g., selecting a column header without any age group). This prevents misinterpretation of program availability. If inconsistent or incomplete, require clarification before accepting the submission.
16
Attestation signature and date required; date format and not in the future
Ensures the attestation is completed with a signature (or acceptable e-signature indicator) and a valid date in an accepted format (e.g., MM/DD/YYYY), and that the date is not in the future. The attestation is critical for compliance and confirms services are within scope of practice. If missing or invalid, reject submission because the form is not legally/operationally complete.
Common Mistakes in Completing GHP BH Services Questionnaire (HPM50)
People often assume one questionnaire covers the whole practice, even when individual clinicians offer different services, age groups, or specialties. This leads to inaccurate directory listings and misdirected referrals (patients may be sent to a provider who doesn’t actually offer the needed service). To avoid this, complete a separate form for each practitioner and only submit a single group form if every practitioner/location truly provides the same services.
Common omissions include missing NPI, incomplete credentials (license type/degree), or an unclear group name. Missing identifiers can delay processing, prevent correct matching in payer systems, and cause directory inaccuracies. Always enter the full individual NPI, list credentials exactly as licensed (e.g., LCSW, LPC, PsyD, MD), and provide the legal group/practice name used for contracting.
Many submit a back-office line, personal cell, or a number that is not used for new patient scheduling. The consequence is failed outreach, longer time-to-care, and member frustration when calls go unanswered or routed incorrectly. Use the primary public-facing scheduling/referral number and confirm it is monitored during business hours.
People frequently omit suite numbers, use a billing address instead of the service location, or forget to include the county. This can misroute patients, create incorrect network directory entries, and complicate referrals that depend on geography. Enter the full service location address (including suite/floor), verify the county, and use a separate form per facility location if locations differ.
Some check every age group to appear broadly available, even if they do not treat children, adolescents, or geriatrics. This results in inappropriate referrals and potential scope-of-practice or competency concerns when members are matched incorrectly. Only check age groups you actively accept today, and ensure your selected services (e.g., PIBHS, ABA) align with the ages you treat.
A common mistake is checking languages based on limited conversational ability or relying on ad-hoc interpretation, and checking American Sign Language without a qualified ASL-capable clinician. This can create access barriers, clinical misunderstandings, and member complaints when communication needs aren’t met. Only select languages in which you can provide clinical services competently, and use the 'Other' field to specify exact languages and any limitations.
Providers sometimes mark high-demand services (e.g., ECT, TMS, esketamine, methadone maintenance, neuropsych testing) even when they are offered by a different entity, require a separate program, or are not available at that location. This leads to incorrect referrals and delays when members discover the service isn’t available. Only check services you directly provide (or your group provides at that location) and that are currently operational, and avoid marking items that are only “planned” or “by referral elsewhere.”
People often check therapies/treatments (e.g., CBT, DBT, EMDR) but forget to indicate the conditions they will treat, or they check conditions without offering the corresponding services. This mismatch can cause poor referral matching and inappropriate expectations for members. Review both sections together and ensure your checked conditions align with your actual competencies and the treatments you provide.
When selecting 'Other' for languages or conditions, many leave it blank or write unclear terms (e.g., “all issues,” “most disorders”). This reduces the usefulness of the directory and can trigger follow-up requests for clarification. If you select 'Other,' specify the exact language/condition/service and keep it clinically clear and searchable (e.g., “Italian,” “Somatic symptom disorder,” “Perinatal loss counseling”).
The PHP/IOP section is easy to misread, and people may check boxes without confirming the program type (PHP vs IOP), diagnosis track (ED/MH/SUD), or the correct age category. This can result in referrals to programs that don’t exist or don’t serve that population, delaying care. Carefully verify each checked box corresponds to an actual program you offer, and confirm the correct level of care and age range before marking it.
Forms are often returned without a signature, date, email, relationship to practice, or fax number. This can invalidate the attestation, delay directory updates, and require rework by the health plan. Ensure the authorized person signs and dates the form and provides complete contact details so Geisinger can confirm any unclear responses quickly.
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