Provider Toolkit: Quick Reference Guide

Simplify Office Administrative Tasks

Keep our Quick Reference Guide nearby to make pre-visit planning and post-visit tasks quick and easy.

Secure Provider Portal:

  • Verify member eligibility
  • Access patient health records
  • View patient gaps
  • Manage prior authorizations
  • Submit and manage claims
  • And more!


Member Eligibility

Check member eligibility via:


Patient Care Gaps

Find recommended services that a member has not completed.

  1. Visit the Secure Provider Portal
  2. Review patient informationfor any gaps in care.
  3. Plan to address care gapsduring future appointment.


Prior Authorization

It is the responsibility of the ordering physician to obtain authorization; and Providers rendering the above services should verify that the necessary authorization has been obtained; failure to do so may result in denial of all or a portion of the claim. Use the Pre-Auth Needed tool on our website to determine if prior authorization is required.

For fast service, submit prior authorization via the Secure Provider Portal. From there you will be able to track the status of the claim and help resolve any issues that might arise during the process.

You may also access Prior auth fax forms on our website and submit requests manually

  • Medical Prior Authorization Fax: 833-603-2871
  • Medical Inpatient Admissions Fax: 833-751-2724
  • Medical Concurrent Review Fax: 833-751-2721
  • Behavioral Health Inpatient Fax: 833-792-2721
  • Better Health Outpatient Fax: 833-792-2720
  • NIA* High Tech Imaging:
  • NIA* Rehabilitation Services and Pain Management:
  • Pharmacy - Envolve Pharmacy Solutions prior authorization can be accessed at under the "CoverMyMeds" link



Timely Filing guidelines: 180 days from date of service.

Claims can be submitted via:

  • Secure Portal
  • Clearinghouses: EDI Payor ID 68069
  • Mail paper claims to:
    Attn: Claims Department
    P.O. Box 5010
    Farmington, MO 63640-5010


Pre-Visit Planning Checklist

  • Verify member eligibility.
  • Check for patient care gaps and address them during upcoming office visit.
  • Use Pre-Auth Needed tool to determine if prior authorization is needed before appointment.