Providers

Aspire contracts with a community of world-class physicians and ancillary providers who care deeply about the community. This dedication to the health and well-being of Aspire Health Plan members makes our provider network an important part of the Aspire Health Plan team.

The information on this page should help providers navigate the services for Aspire Health Plan. 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) 657-0700, or email us at Network_Support@AspireHealthPlan.org

Aspire Health Plan and MBIPA – Contact Information

Quick Reference Contact Guide – Printable PDF  |  Effective 1.1.2023 to 12.31.2023  |   Updated 1.1.2023
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

• MedImpact
  www.medimpact.com
  (888) 495-3160

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

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

Credentialing and Contracting

• Provider Networks and Contracting Manager
  (831) 657-0700
  For assistance, please email  network_support@aspirehealthplan.org

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

Professional network provided by: Monterey Bay Independent Physician Association

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

Medicare Providers Serving People with Both Medicare and Medi-Cal

This toolkit is designed to give providers like you information about Medi-Cal managed care changes, for your patients with both Medicare and Medi-Cal.