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Important Update to the Prior Authorization Process for Specialized Musculoskeletal Therapies

Effective July 1, 2022, Health Partners Plans (HPP) requires therapy providers to use the prescribing physician NPI as the requesting provider when submitting prior authorization (initial and continued care) requests to eviCore healthcare for the following services:

  • Occupational therapy
  • Physical therapy
  • Speech language therapy
  • Chiropractor services

This change will ensure the physician name is included on the determination letter that goes out to the member, which is a PA DHS directive, and will not affect payment. Please continue to use the group/facility NPI as the rendering facility/site selection.

What this means for you?

When you use the eviCore healthcare provider portal, you will need to add ordering physician NPI to your user account so it is available to you during the case build. Go to the “Manage Your Account” tab to add the MD or DO.

If you do not have the ordering provider MD/DO NPI, the case will not be viable for submission; you will get a “hard stop” in the case build process. Please note that PAs and NPs will not be accepted as the requesting provider as per the DHS directive.

For updated training information, please visit www.evicore.com/resources/healthplan/health-partners-plans.

If you have questions, call HPP’s Provider Services Helpline at 1-888-991-9023 (Monday – Friday, 9 a.m. – 5:30 p.m.). Thank you for being part of the HPP participating provider network and your anticipated partnership to provide great service to our members.