Health Partners/Jefferson Health Plans
Quick Reference Guide
- Quick Reference Guide (PDF)
Model of Care Training
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Take the Health Partners Plans Model of Care Training for Care Management Providers.
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Complete the Attestation for Model of Care Training.
Pennsylvania Prior Authorization Process for Commercial and CHIP Plans
Medical Necessity Criteria/Medical Policy
Substance use disorder:
- American Society of Addiction Medicine (ASAM) and An Introduction to The ASAM Criteria for Patients and Families (PDF) - Licensee's use and interpretation of the American Society of Addiction Medicine’s ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits.
Applied behavior analysis, transcranial magnetic stimulation, and psychological testing:
Other mental health services:
- Additional criteria are available here.
Prior Authorization Requirements
- Preauthorization requirements for Health Partners Plan / Jefferson Health Plan CHIP and Exchange (PDF)
Requesting Prior Authorization
Some facility and non-routine outpatient services may be requested online via the Request Member Care application.
- Sign into this website and select Request Member Care from the left-hand menu.
- If the provider portal (Request Member Care app) is not available, you may contact Magellan at 1-800-424-3702 for Health Partners CHIP members and 1-800-424-3706 for Health Partners/Jefferson Health Plan Exchange members for authorization.
Tutorials:
User guides:
- Request Member Care – Facility services (PDF)
- Request Member Care – Non-routine outpatient services (PDF)
For services that require prior authorization and are not accessible through the Request Member Care application, complete the appropriate form below and fax it to Magellan.
- For autism-related forms, sign in to this website. From the Resources section, select State & Plan Information, then choose Autism-Specific Information to access:
- ABA Initial Authorization
- ABA Treatment Plan/Concurrent Review
- Psychological Testing Preauthorization Request Form (PDF)
- ECT Authorization Request Form (PDF)
- TMS Authorization Request Form (initial and concurrent, PDF)
- Fax number for completed form submissions:
- ABA: 1-888-656-4925
- Psychological testing and ECT: 1-888-656-0259
- TMS: 1-888-656-4967
- Customer service numbers:
- Health Partners CHIP: 1-800-424-3702
- Health Partners/Jefferson Health Plan Exchange: 1-800-424-3706
- Provider Services Line: Chat with us or contact us at 1-800-788-4005 for technical issues with the website.
Requesting a Peer-to-Peer Consultation
To request a peer-to-peer consultation, contact Magellan’s Utilization Management Support Team at 1-800-741-2304, option 3, then Option 2.
- Peer-to-peer process (PDF)