Effective 1/1/2022. Use this form to request Prior Approval for Behavioral Health Services.

Use this form if you are a provider requesting a review of a previously processed claim. 

Effective 1/1/2022. Use this form to request Prior Approval for medications utilizing the medical benefit.

Use this form to request Prior Approval for medications utilizing the pharmacy benefit.

Effective 1/1/2022. Use this form to request Prior Approval for all services except Behavioral Health and medical benefit medications.

This form is only used for requesting a formal appeal of any adverse determinations.

If you are an existing provider and are adding new practitioners or changing information about existing practitioners, please fill out this form and return it to the email address noted in the form.

If you are an existing provider and you are adding a new practice location or changing information about an existing practice location, please fill out this form and return it to the email address noted in the form.

If you are an out-of-network provider looking to join the Health Options network, please fill out this form and return it to contracting@healthoptions.org. Once you have received a response from the Health Options’ Contracting Department, you may be instructed to fill out the Assessment Form found below. 

All facilities and non-credentialed providers must complete this assessment application. For facilities contracted with us, you must be reassessed every three years. You may be instructed to complete this form upon contracting with us.

If you are an existing provider that wants to register for electronic funds transfer (EFT) and claims information by electronic remittance advice (ERA), please fill out this form and return it to Instamed by following the instructions on the form.

If you are an existing provider and you are adding a new practice location or if you are changing an existing practice location’s TIN, please fill out this form and return to contracting@healthoptions.org.

If you are an out-of-network provider looking to join the Health Options’ network, please complete this form and return to contracting@healthoptions.org upon response from Health Options’ Contracting Department regarding your Health Options New Contract Inquiry Form.

We regard our relationship with you as a vital partnership and want to play a role in improving your health and wellbeing. Understanding your rights and responsibilities will help you to get the most out of your plan and be your healthiest self.

Use this guide to understand your rights and options in the event that a service is denied.

Once you complete these steps, you will land on the Availity Portal home page where you’ll receive a notification with instructions on registering your organization.

Updated 1/1/22. An overview of Behavioral Health Prior Approval and Notification Requirements.

Key points for providers on correct coding.

Updated 1/1/22. An overview of Durable Medical Equipment Prior Approval Requirements.

This document provides current Healthcare Effectiveness Data and Information Set (HEDIS) measures that support Health Options’ accreditation as a Qualified Health Plan (QHP). A high QHP rating is an indicator of the quality of healthcare services received by our Members.

Updated 1/1/22. An overview of services, procedures and surgeries that require Prior Approval.

This guide provides an overview of medication management for both the medical and pharmacy benefit, including Prior Authorization requirements, through Health Options Medical Management and Express Scripts, Health Options Pharmacy Benefit Manager (PBM).

Updated 1/1/22. An overview of medications that require Prior Approval.

Updated 1/1/22. An overview of Utilization Management Requirements.

This summary of Health Options Quality Improvement Program includes the goals and objectives of our program and expectations of providers to participate in quality activities.

Risk adjustment coding tips to improve clinical documentation for providers.