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Authorizations &

Appeals

To request an authorization (coverage determination) for services (medical or I/DD Waiver), contact your patient’s Interdisciplinary Team (IDT) or call our Utilization Management department at 1-855-769-2508.

Authorization Requests

To request an authorization (coverage determination) for services (medical or I/DD Waiver), contact your patient’s Interdisciplinary Team (IDT) or call our Utilization Management department at 1-855-769-2508.

You may fax a prior authorization request form and clinical documentation to our Utilization Management department at 1-855-769-2509.

For NEW Inpatient Admissions, you may also submit a prior authorization request directly through our Utilization Management Provider Portal. Note this is not applicable to previous or existing authorizations. Visit the Utilization Management Provider Portal page to learn more and to register to utilize this portal. 

Mail us an authorization request for services (medical or I/DD Waiver) at:

PHP Care Complete FIDA-IDD Plan
Utilization Management
1311 W President George Bush Highway, Suite 100
Richardson, TX 75080



To request a coverage determination for any prescription drugs, you should submit a Medicare Prescription Drug Coverage Determination request form for your patient.


Appeals

To file an appeal for services (medical or I/DD Waiver), you can:

Call our appeals department at 1-855-769-2508; OR

Fax your appeal to us.  Our fax number is 1-855-769-2509; OR

Write your appeal and mail it to us at:

PHP Care Complete FIDA-IDD Plan
Appeals Department
1311 W President George Bush Highway, Suite 100
Richardson, TX 75080

To file an appeal related to prescription drugs, you can submit a Request for Redetermination of Medicare Prescription Drug Denial on behalf of your patient, fax your appeal to us:

Appeal Requests

  • Phone: 1-888-648-6759
  • Fax: 1-858-790-6060
Mail your coverage redetermination to us at:
PHP Care Complete FIDA-IDD Plan Coverage Redeterminations
10181 Scripps Gateway Court, Ste. 123
San Diego, CA 92131

Grievances

Call Provider Services at 1-855-747-5483
or TTY/TDD: 711

Write your grievance and mail it to us at:

Effective 6/30/23 - Please mail your grievance to:
Partners Health Plan
P.O. Box 240356
Apple Valley, MN 55124

Most grievances are answered in 30 calendar days. If possible, we will answer you right away. If you call us with a grievance, we may be able to give you an answer on the same phone call.

If you need a response faster because of the health of your patient, we will give you an answer within 48 hours after we get all necessary information (but no more than 7 calendar days from the receipt of your grievance).

Authorization Request Forms & Submission Instructions

Prior Authorization Requests

Prior Authorization Requests

Send completed form and supplemental clinical to Health Smart fax number 855-769-2509 Incomplete forms or lack of supplemental clinicals can result in the delay of case set up and processing.

Part D Coverage Determination Requests

Part D Coverage Determination Requests

  • Phone: 1-888-648-6759
  • Fax: 1-858-790-7100
  • Mail your coverage determination to us at:
PHP Care Complete FIDA-IDD Plan Coverage Determinations
10181 Scripps Gateway Court, Ste. 123
San Diego, CA 92131
Continuous Glucose Monitor (CGM) Requests

Continuous Glucose Monitor (CGM) Requests

To request a GCM please complete the Continuous Glucose Monitor Request form for your patient and fax the form and clinical documentation to (646) 948-1027.
DME Prior Authorization Requests

DME Prior Authorization Requests

Please contact 646-455-1594 for DME related questions. Send completed form and supplemental clinical to fax number 646-948-1027 Incomplete forms or lack of supplemental clinicals can result in the delay of case set up and processing.

Utilization Management Provider Portal

Authorization Requirements

Appointment of Representative Form

Waiver of Liability Form

Need Provider Assistance?

The Partners Health Plan Network Development and Provider Relations team is here to assist you with your billing, claims, authorization, education, and any other general inquiry. Use the Contact Us button below to complete a Provider Ticket Submission Form.

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