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Aspire Health Plan and MBIPA – Contact Information

Medical Authorizations

Details on submitting authorization requests and services that require prior authorization.

Claims Submission

Information on electronic, paper-based, and dual-plan claim submissions.

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

2024 Quick Reference Contact Guide
Effective 1.1.2024 to 12.31.2024 | Updated 1.1.2024
Aspire Health Protect (HMO) Aspire Health Value (HMO) Aspire Health Advantage (HMO) Aspire Health Plus (HMO-POS) Aspire Health Group Plus (HMO-POS)
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
Log on to check eligibility, review claim status, or submit a prior authorization.
id.phtech.com
(503) 584-2169 option 2
support@phtech.com

Member Advocate
Please refer members requiring extra assistance with coordinating care or scheduling transportation to visits.
(831) 644-7425
memberadvocate@aspirehealthplan.org
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 requests electronically on the provider portal.

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

2024 Authorization Request Form (PDF):
(Last Revised 12/2023) English | Español

Part B Provider Bulletins

Part B Provider Bulletin – (3/2024)

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)
Select Part B drugs (see drug coverage 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: (currently unavailable)
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.

Payment Integrity

At Aspire Health Plan, we are dedicated to safeguarding the financial well-being of our members and being responsible stewards of healthcare resources. Our commitment to payment integrity is a testament to our mission of delivering high-quality care to our members while ensuring fiscal responsibility.

Guided by CMS (Centers for Medicare & Medicaid Services) regulations and industry best practices, we have established a robust program and engaged a vendor, Integrity Advantage, to support our payment integrity efforts. We understand that a sustainable healthcare system relies on accurate and accountable financial practices.

Special Investigations Unit (Provider Requirements):
This policy describes the identification, investigation, appeal and overpayment recovery process the Plan follows.

Give Us a Call

Prospective Members
Toll-free: (866) 798-1530 (TTY 711)

Current Members
Toll-free: (855) 570-1600 (TTY 711)
Local: (831) 574-4938 (TTY 711)

We’re Here For You

Hours

October 1 to March 31
7 Days a Week
8 a.m. to 8 p.m. PT

April 1 to September 30
Monday – Friday
8 a.m. to 8 p.m. PT

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Authorization Request Form (PDF): English | Español

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Aspire Health Plan is a Medicare Advantage HMO plan sponsor with a Medicare contract. Enrollment in Aspire Health Plan depends on contract renewal.

Medicare beneficiaries may also enroll in Aspire Health Plan through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. Every year, Medicare evaluates plans based on a 5-star rating system. For accommodation of persons with special needs at meetings call 1-855-570-1600 (TTY: 711) Other Providers are available in our network. Out-of-network/non-contracted providers are under no obligation to treat Aspire Health Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

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