February 24, 2025

Thank you for being a valued provider for members in one or more of our health plans: Health Partners Plans Medicaid, Health Partners Plans CHIP, Jefferson Health Plans Medicare Advantage, and/or Jefferson Health Plans Individual and Family Plans.

On August 6, 2024, we notified our provider network of a change in prior authorization requirements for sleep studies rendered in a facility setting. Effective with dates of service on or after February 15, 2025, sleep studies rendered in a facility setting will no longer require a prior authorization. This change affects all lines of business (Health Partners Plans Medicaid, Health Partners Plans CHIP, Jefferson Health Plans Medicare Advantage, Jefferson Health Plans Individual and Family Plans).

No changes have been made to outpatient sleep studies, and they will continue to not require prior authorization. 

Non-participating providers may require authorization as a condition of payment based on the member’s individual coverage. For information on products/services that require authorization as a condition of payment for out of network services, please contact the Utilization Management/Prior Authorization line at 1-866-500-4571, then select prompts 2 and 4.

Please submit prior authorization requests through our provider portal. 

If you have any questions, please call our Provider Services Helpline at 1-888-991-9023 (Monday - Friday, 9 a.m. to 5:30 p.m.).