Health Partners Plans Provider Resources
Please download and read through the following material. Our goal is to make the change to EviCore by Evernorth as seamless and easy as possible and these documents will explain the process. There is contact information in the material if you have any questions.
If you are searching for resources related to a commercial or Medicare member, please click HERE
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.
Important Update to the Prior Authorization Process for Specialized Musculoskeletal Therapies
Beginning July 1, 2022, Health Partners Plans is asking therapy providers to use the prescribing physician NPI as the requesting provider when submitting prior authorization (initial and continued care) requests to EviCore by Evernorth for the following services:
Occupational Therapy | Physical Therapy | Speech Language Therapy | Chiropractor Services
This change will ensure that the individual ordering licensed practitioner’s name is included on the determination letter that goes out to the member. It will not affect payment. Continue to use the group/facility NPI as the rendering facility/site selection.
Medical Oncology
Radiology
Cardiovascular
Musculoskeletal
Radiation Oncology
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Registration Instructions
EviCore highly recommends providers take full advantage of the online capabilities at https://www.evicore.com/provider
Here you can request prior authorization, review our nationally accepted evidence-based guidelines, and receive announcements about program updates. Access requires only your email address and a brief registration.