Providers

In Monterey County we are blessed to have a community of world-class physicians and ancillary providers who care deeply about the community we serve. This dedication to the health and well-being of Aspire Health Plan members makes our provider network a critical part of the Aspire Health Plan team. We truly appreciate all that they do.

We will make relevant information available here, to help our provider network navigate caring for Aspire Health Plan’s membership. If you are unable to find the information you need on this page, please call Member Services at (831) 574-4938 or (855) 570-1600 for questions about eligibility and benefits or call Aspire’s Provider Services Team at (831) 644-7437, or email us at Network_Support@AspireHealthPlan.org

Aspire Health Plan and MBIPA – Contact Information

Quick Reference Contact Guide – Printable PDF  |  Effective 1.1.2021 to 12.31.2021  |   Updated 1.1.2021
Aspire Health Advantage (HMO)  |  Aspire Health Plus (HMO-POS)  |  Aspire Health Group Plus (HMO-POS) |  Aspire Health Value (HMO)

Member and Provider Customer Services

  • Phone: (831) 574-4938 or (855) 570-1600 (TTY: 711)
  • Fax: (831) 574-4939 or (855) 519-5769

Prescription Drug Benefits / Prescription Prior Authorizations

Provider Portal Website

  • id.phtech.com
    (503) 584-2169 option 2
    support@phtech.com
    Log on to check eligibility, review claim status, or submit a prior authorization.

Member Advocate

  • Rebecca Jacobs — (831) 644-7425 or memberadvocate@aspirehealthplan.org
    Please refer members requiring extra assistance with coordinating care or scheduling transportation to visits.

Credentialing and Contracting

  • Melissa Bates, Provider Networks and Contracting Manager
    (831) 644-7437

Eligibility / Plan Coverage Information, Decisions and Appeals

  • Phone: (831) 574-4938 or (855) 570-1600 (TTY:711)
  • Fax: (831) 574-4939 or (855) 519-5769

Monterey Bay Independent Physician Association Professional Credentialing and Contracting

 

MEDICAL AUTHORIZATIONS

Aspire Health Plan
Submit authorization request electronically at:  id.phtech.com.
If you do not have a portal account and would like to establish one, please call (503) 584-2169
Call: (831) 574-4938 or (855) 570-1600
Fax: (831) 657-2669

Services that Require Prior Authorization (Authorization List)

  • Inpatient admissions
  • Durable Medical Equipment over $500
  • Inpatient rehabilitation facility
  • External Prosthetic Devices over $500
  • Skilled Nursing Facility
  • CT, MRI/MRA, PET scan, Nuclear Medicine (including SPECT), Angiography
  • Genetic and Molecular Diagnostic Testing
  • Mental health partial hospitalization
  • Radiation Oncology
  • Outpatient Surgery (including wound care)
  • Select Part D drugs (see formulary for details)
  • Non-emergent Ambulance
  • Non-contracted providers
  • Intensive Outpatient Substance Abuse services
  • Any Out-of-Network Referrals
  • Occupational, Physical, Speech Therapy (after 12 visits, per calendar year)
  • Home Health Services

 

CLAIMS SUBMISSION

Electronic Submission

  • Clearing House:
    Office Ally — www.officeally.com
    Payor ID: ASP01
    Office Ally phone number: (866) 575-4120
  • Clearing House:
    ChangeHealthcare
    Payor ID: 46156

For electronic claim submission assistance, please email
edi.support@phtech.com or call (503) 584-2169 option 1

Paper Submission

  • Aspire Health Plan
    P.O. Box 5490
    Salem, OR 97304

For paper claim submission assistance, please call (855) 570-1600