Accessibility Tools

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.

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

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

PHP Care Complete FIDA-IDD Plan
Utilization Management
222 W. Las Colinas Blvd. Suite 500N
Irving, TX 75039

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

Authorization Requirements

View Requirements

Appointment of Representative Form

View / Complete Form

Waiver of Liability Form

View / Complete Form

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.

Prior Authorization Request Form
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
Coverage Determination Request Form
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.
Continuous Glucose Monitor (CGM) Request Form
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.

DME Prior Authorization Request Form

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
222 W. Las Colinas Blvd. Suite 500N
Irving, TX 75039

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:

 2022 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

Fax your grievance to us.  Our fax number is 1-844-566-8296

Write your grievance and mail it to us at:

PHP Care Complete FIDA IDD
P.O. box 16309
Lubbock TX 79490

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).

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.

Contact Us

H9869_PHPWeb_Authorizations and Appeals_2022_Pending

Contact Us
  • Partners Health Plan
  • 2500 Halsey Street
    Bronx, NY 10461
  • (855) PHP-LIVE or (855) 747-5483
  • TTY:711
  • 8am-8pm, 7 days a week

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855-747-5483 | TTY/TDD:711
Partners Health Plan is a managed care plan that contracts with Medicare and the New York State Department of Health (Medicaid) to provide benefits to Participants through the Fully Integrated Duals Advantage for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD) Demonstration.

H9869_PHPWeb_Approved

The State of New York has created a Participant Ombudsman Program called the Independent Consumer Advocacy Network (ICAN) to provide participants free, confidential assistance on any services offered by Partners Health Plan. ICAN may be reached toll-free at 1-844-614-8800 (TTY users call 711, then follow the prompts to dial 844-614-8800) or online at icannys.org.

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