Jefferson Health Plans Provider Resources

Effective 10/01/2024, EviCore will cease processing sleep study prior authorization requests for Health Partners Plans/Jefferson Health Plans. 

 Home-based and facility-based sleep studies will no longer require prior authorization.  However, Medicaid and HMO product out-of-network provider requests for sleep studies will be managed by Health Partners Plans/Jefferson Health Plans. 

 EviCore will also cease processing therapy prior authorization requests for CHIP membership as the prior authorization requirement has been removed. 

 Should you have any questions, please contact Health Partners Plans/Jefferson Health Plans. 

Effective 10/01/2024, EviCore will also cease processing physical, occupational, and speech therapy prior authorization requests for CHIP membership only, as the prior authorization requirement has been removed.

Effective January 1, 2024, Jefferson Health Plans members with plans that require prior authorization from EviCore will require requests to be submitted via the CareCore National portal for the following programs:

•        Cardiovascular Advanced Imaging
•        Musculoskeletal Services: Pain, Joint and Spine Procedures
•        Radiology Advanced Imaging
•        Sleep Management

Services performed without authorization may be denied for payment, and you may not seek reimbursement from members.  For training session dates and times, please see the General Resources tab and the Solution Resources tab.