Some services, medicines, or items need approval from Health Partners Plans before you can get the service. This approval process is called prior authorization. “Prior authorizations” are sometimes referred to as “preauthorizations” or “precertifications” or “preapprovals” – they mean the same thing.
For some services that need prior authorization, Health Partners Plans decides whether a requested service, medicine, or item is medically necessary before you get the service. You or your provider must make a request to us for approval.
Examples of services that require prior authorization include physical therapy and some prescriptions.
Note: Health Partners Plans requires prior authorizations for some services that are performed in an outpatient/inpatient setting, including services performed in the office, short procedure units, ambulatory surgery centers, clinics, and hospital outpatient departments.
When a service, item, or medicine requires prior authorization from Health Partners Plans before it can be provided to you, your provider typically will submit the prior authorization request with current doctor's orders and supporting clinical documentation through our online provider portal. Your provider may also fax the request to us at 215-849-7096 or call in the request by phone to 1-888-991-9023.
Please talk to your PCP or specialist or call our 24-hour Member Relations line at 1-888-888-1211 (TTY 1-877-454-8477) if:
Member Relations can also help you find a doctor or get a listing of participating providers.
If you would like a copy of the medical necessity guidelines or other rules that are used to decide your prior authorization request, send a written request to:
Health Partners Plans
ATTN: Complaints and Grievances Unit
1101 Market Street, Suite 3000
Philadelphia, PA 19107
You can also call Member Relations at 1-888-888-1211 (TTY 1-877-454-8477) to request medical necessity criteria. Providers should call the Provider Services Helpline at 1-888-991-9023.
Here is a list of services that require prior authorization
You may also need to receive approval or prior authorization to receive certain medications. The following kinds of medications may require prior authorization:
For more information regarding prior authorizations, including review timeframes, outpatient drugs, denials, program exceptions and more, please review your Member Handbook.