Provider materials and tools

Find important fax numbers

Please do not fax to multiple fax numbers, this may impact our response time. 

Prior Authorizations

Elective prior authorization requests and provider correspondence

1-888-656-4083

Examples:

  • Request for services requiring prior authorization & authorization status
  • Signed Single Case Agreement (SCA) forms
  • Requests for retrospective/post service review
  • Medical records (not pertaining to a current admission or an appeal)

Concurrent Reviews

Inpatient admissions

1-888-656-4894

Examples:

  • Initial notification of emergency inpatient hospital admissions with clinical information
  • Initial notification of emergency inpatient observation days
  • All subsequent clinical information for on-going concurrent review

Appeals

Medical records and corresponding appeal summaries

1-888-656-4864 

Examples:

  • Clinical Medical Necessity Denial appeals (must be the result of an Adverse Benefit Determination (ABD) formerly Notice of Action (NOA))
  • Administrative Denial Appeals (must be the result of a NOA)
  • Claim denials for 45-day Inpatient Benefit Exhaustion (BBA)
  • Claim denials for Provider Preventable Condition reviews

Care Coordination

Care integration, communication tools and documents

1-888-656-6164 

Examples:

  • Case Management referrals and inquiries
  • Provider administered Health Risk Assessments (HRAs)
  • Family member or Provider administered Consent to Release Protected Health Information (PHI)
  • Power of Attorney or other legal documents