Prior Authorization Services

Physician Health Partners performs prior authorization services and medical management functions for the health plans contracted with PHP. This department is responsible for pre-certifying referrals for all services that require prior authorization. PHP utilizes internally developed criteria along with Milliman Care guidelines to determine if a service is medically appropriate. All guidelines utilized by PHP are reviewed and approved by a committee comprised of area physicians and Physician Health Partners’ medical directors.

Precertification requests can be submitted online through MCS, an internet-based secure application available to participating providers to expedite the authorization process.