{"id":1426,"date":"2022-11-17T08:51:57","date_gmt":"2022-11-17T16:51:57","guid":{"rendered":"https:\/\/\/?page_id=1426"},"modified":"2024-12-10T15:55:04","modified_gmt":"2024-12-10T23:55:04","slug":"health-plan-pre-service-information","status":"publish","type":"page","link":"https:\/\/www.qualityhealth.org\/adminsimp\/health-plan-pre-service-information\/","title":{"rendered":"Health Plan Pre-Service Information"},"content":{"rendered":"

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The Pre-Service Directory has been discontinued effective July 25, 2020 due to low utilization. Some of the health plans’ pre-service information is provided below as a quick reference. If you have specific pre-service questions, please work directly with the health plans.<\/span><\/p>\n

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  1. Medical Policy\/Guideline Update List by Health Plan<\/a><\/li>\n
  2. Pre-Service Links by Health Plan<\/li>\n<\/ol>\n<\/div>\n<\/div>\n<\/article>\n<\/div>\n

    [\/vc_column_text][vc_column_text css=””]<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
    Health Plan<\/strong><\/td>\nPre-Service Link<\/strong><\/td>\nComment – Other Related URLs<\/strong><\/td>\n<\/tr>\n
    Amerigroup – DSNP<\/td>\nhttps:\/\/providers.amerigroup.com\/Pages\/PLUTO.aspx<\/a><\/td>\n<\/td>\n<\/tr>\n
    CHPW – Medicare Advantage<\/td>\nhttps:\/\/medicare.chpw.org\/provider-center\/prior-authorization\/<\/a><\/td>\n<\/td>\n<\/tr>\n
    Coordinated Care – Ambetter<\/td>\nhttps:\/\/www.coordinatedcarehealth.com\/providers\/preauth-check\/ambetter-pre-auth.html<\/a><\/td>\n<\/td>\n<\/tr>\n
    First Choice Health (TPA and PPO)<\/td>\nhttps:\/\/www.fchn.com\/Providers<\/a><\/td>\n<\/td>\n<\/tr>\n
    HCA Apple Health – Medicaid FFS<\/td>\nhttps:\/\/www.hca.wa.gov\/billers-providers-partners\/prior-authorization-claims-and-billing\/prior-authorization-pa<\/a><\/td>\nProvider Billing Guides & Fee Schedules<\/a><\/td>\n<\/tr>\n
    HCA Apple Health – Amerigroup<\/td>\nhttps:\/\/providers.amerigroup.com\/Pages\/PLUTO.aspx<\/a><\/td>\n<\/td>\n<\/tr>\n
    HCA Apple Health – CHPW<\/td>\nhttps:\/\/www.chpw.org\/for-providers\/prior-authorization-and-medical-review\/<\/a><\/td>\n<\/td>\n<\/tr>\n
    HCA Apple Health – Coordinated Care<\/td>\nhttps:\/\/www.coordinatedcarehealth.com\/providers\/preauth-check\/medicaid-pre-auth.html<\/a><\/td>\n<\/td>\n<\/tr>\n
    HCA Apple Health – Molina<\/td>\nhttps:\/\/provider.molinahealthcare.com\/<\/a><\/td>\n\n
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    • Log in to OHP<\/li>\n
    • Click on Molina Healthcare Logo<\/li>\n
    • On the WebPortal Main Page click on Forms<\/li>\n
    • Scroll down to Prior Authorization by CPT code Guide. Be sure to select the guide that coincides with the date of service you are looking up. Be sure to review the column appropriate to the coverage plan – Medicaid, Medicare or Marketplace.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
    HCA Apple Health – UHC Community Plan<\/td>\nhttps:\/\/www.uhcprovider.com\/en\/prior-auth-advance-notification.html<\/a><\/td>\n<\/td>\n<\/tr>\n
    Kaiser Permanente Oregon and Southwest Washington<\/td>\nhttps:\/\/extsso.kp.org\/kpsso-ap\/signIn.html<\/a><\/td>\n<\/td>\n<\/tr>\n
    Kaiser Permanente Washington<\/td>\nhttps:\/\/wa-provider.kaiserpermanente.org\/clinical-review<\/a><\/td>\nhttps:\/\/wa-provider.kaiserpermanente.org\/provider-manual\/index<\/a><\/td>\n<\/tr>\n
    Labor & Industries<\/td>\nhttps:\/\/lni.wa.gov\/patient-care\/authorizations-referrals\/authorization\/<\/a><\/td>\nhttps:\/\/lni.wa.gov\/patient-care\/billing-payments\/fee-schedules-and-payment-policies\/<\/a><\/td>\n<\/tr>\n
    Molina – Marketplace<\/td>\nhttps:\/\/provider.molinahealthcare.com\/<\/a><\/td>\n\n
      \n
    • Log in to OHP<\/li>\n
    • Click on Molina Healthcare Logo<\/li>\n
    • On the WebPortal Main Page click on Forms<\/li>\n
    • Scroll down to Prior Authorization by CPT code Guide. Be sure to select the guide that coincides with the date of service you are looking up. Be sure to review the column appropriate to the coverage plan – Medicaid, Medicare or Marketplace.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
    Premera Blue Cross<\/td>\nhttps:\/\/www.premera.com\/wa\/provider\/utilization-review\/about-prior-authorization\/<\/a><\/td>\n<\/td>\n<\/tr>\n
    Providence Health Plans<\/td>\nhttps:\/\/phpprovider.providence.org\/portal\/<\/a><\/td>\nClick on Authorization Codes for \u2018Combined Prior Authorization List\u2019<\/td>\n<\/tr>\n
    Regence<\/td>\nhttps:\/\/www.regence.com\/provider\/pre-authorization\/commercial<\/a><\/td>\n<\/td>\n<\/tr>\n
    UHC – Commercial<\/td>\nhttps:\/\/www.uhcprovider.com\/en\/prior-auth-advance-notification.html<\/a><\/td>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    This should correctly display the table with your health plan links and related details in WordPress. Let me know if you need further adjustments![\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"[vc_row][vc_column][vc_column_text css=””] The Pre-Service Directory has been discontinued effective July 25, 2020 due to low utilization. Some of the health plans’ pre-service information is provided below as a quick reference. If you have specific pre-service questions, please work directly with the health plans.   Medical Policy\/Guideline Update List by Health Plan Pre-Service Links by Health…","protected":false},"author":132,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"class_list":["post-1426","page","type-page","status-publish","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.qualityhealth.org\/adminsimp\/wp-json\/wp\/v2\/pages\/1426","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.qualityhealth.org\/adminsimp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.qualityhealth.org\/adminsimp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.qualityhealth.org\/adminsimp\/wp-json\/wp\/v2\/users\/132"}],"replies":[{"embeddable":true,"href":"https:\/\/www.qualityhealth.org\/adminsimp\/wp-json\/wp\/v2\/comments?post=1426"}],"version-history":[{"count":21,"href":"https:\/\/www.qualityhealth.org\/adminsimp\/wp-json\/wp\/v2\/pages\/1426\/revisions"}],"predecessor-version":[{"id":1984,"href":"https:\/\/www.qualityhealth.org\/adminsimp\/wp-json\/wp\/v2\/pages\/1426\/revisions\/1984"}],"wp:attachment":[{"href":"https:\/\/www.qualityhealth.org\/adminsimp\/wp-json\/wp\/v2\/media?parent=1426"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}