Referrals and Authorizations

Referral and Authorization Requirements 

Remember to verify member eligibility and benefits prior to the service. The following are resources for determining referral and authorization requirements:

AllWays Health Partners Network Providers  AllwaysLogo_2_Color_RGB

Providers who are contracted directly with AllWays Health Partners must submit referral and prior authorization requests online through our Provider Portal. (note: services managed by a vendor should be submitted directly to the vendor - see below)

Referral and Authorization Submission User Guides:

Register for the portal

All Other Providers 

Providers who are not contracted directly with AllWays Health Partners can now submit medical authorization requests online through this authorization request form. This includes:

  • Aetna Signature Administrators network providers
  • MultiPlan PHCS network providers
  • Out-of-network providers

(note: services managed by a vendor should be submitted directly to the vendor - see below)

Authorization Form

Services Managed By A Vendor

Authorization requests for the following services are managed through a vendor partner:

 

Behavioral Health Services (managed by Optum) 

Provider Service (PHS Employee Plans): 844-451-3520

Provider Service (All Other Plans): 844-451-3518

Visit the Optum Provider Express Portal for more information and to submit prior authorization requests.

 

Pharmacy Services (managed by CVS Caremark) 

Partners HealthCare Employee Plan Requests 

  • Phone: 800-364-6331

Specialty Drug Requests (All Other Plans)

  • Phone: 866-814-5506
  • Fax: 866-249-6155

Non-Specialty Drug Requests

  • Commercial Plans
    • Phone: 800-294-5979
    • Fax: 888-836-0730
  • Health Connector Plans
    • Phone: 855-582-2022
    • Fax: 855-245-2134
  • My Care Family
    • Phone: 877-433-7643
    • Fax: 866-255-7569

 

Medical Specialty Drugs (managed by NovoLogix)

Provider Service: 844-345-2803

Fax: 844-851-0882

Prior Authorization Request Form

Medical Specialty Drugs Requiring Prior Authorization

Infusion Therapy Drugs Requiring Prior Authorization When Administered Outside the Home Setting

 

Sleep Management Program (managed by CareCentrix)

Provider Service: 866-827-5861

Visit the CareCentrix portal for more information and to submit prior authorization requests.

 

High-Tech Radiology, Cardiac Imaging and Diagnostic Services, Molecular and Genetic Testing, Radiation Therapy (managed by eviCore)

Provider Service: 888-693-3211

Provider Resources

Visit the eviCore Provider Portal for more information and to submit prior authorization requests.