Authorizations & Appeals
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:
Partners Health Plan Utilization Management Department
Utilization Management
4700 MacCorkle Ave SE, Ste 104
Charleston, WV 25304-1922
Phone: 855-769-2508
Fax: 855-769-2509
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
4700 MacCorkle Avenue SE, Ste 104
Charleston, WV 25304-1922
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
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
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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.
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Part D Coverage Determination Requests
- Phone: 1-888-648-6759
- Fax: 1-858-790-7100
- Mail your coverage determination to us at:
10181 Scripps Gateway Court, Ste. 123
San Diego, CA 92131 -
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
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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