Medical Policy, Pharmacy Policy, & Provider Information

Providence Health Plan, Providence Health Assurance, and Providence Health Plan Partners




**Please Note**

Temporary Operational Changes During COVID-19

Providence Health Plan (PHP) is committed to assisting our members and provider partners during this uncertain time. Due to cancellation/rescheduling of non-emergent procedures and other services and the need to conserve personal protective equipment (PPE), PHP is implementing the following medical management adjustments:




Prior-authorization and Referral Request Extensions

  • Approved prior-authorizations (including medical procedures/services, AIM imaging services, Evicore rehab services) and referral requests received between 2/1/2020-6/15/2020 will be extended until 9/30/2020.
  • A referral may not be required for Providence Medicare Advantage Plan members to receive out-of-network care during a disaster.
  • Approved Medicaid prior-authorizations will be extended until the end of the year.
  • Please note, extensions only apply to the date span of the original request and will not alter the frequency or units or any additional services not otherwise originally approved. If additional procedures/services are necessary, please submit a new prior authorization for review.
  • Extensions only apply to approved authorizations for services not yet rendered.
  • No further action by you or your staff is necessary — PHP will process extension updates to referrals and prior authorizations.
  • Please note, extension dates may change based evolving circumstances related to COVID-19.
  • Extension dates noted above are general guidelines which should not supersede extension dates individually communicated to members and providers.


Out-of-network Requests
  • This change will be in addition to current UM practices and procedures for OON requests, such as network availability, capacity, and medical necessity of services. >
  • Providence Medicare Advantage Plans may cover services rendered by out-of-network providers during a disaster at in-network costs. This coverage is available regardless of the type of plan you are enrolled in.

Providence Health Plan remains open and is operating under normal business hours.

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