Important update regarding Ascension network eligiblity, claim submissions and prior authorizations
Updated 5/9/2024
In response to the current interruption in accessing Ascension network system information, we wanted to provide an update to all doctors and clinicians on eligibility, claim submissions and prior authorizations.
For eligibility verification:
For APC and SmartHealth eligibility inquiries:
- Please refer to the Provider Portal. The Provider Portal is updated to May 8, 2024.
For Dell Children's Health Plan:
- Please refer to the Provider Portal. The Provider Portal is updated to May 8, 2024.
- For eligibility issues please call Member Services.
For claim submission, status or questions:
For claim questions please refer to the Provider Portal. You may continue to submit claims electronically; however, you may experience delays.
For new authorization requests:
This message applies to in-network inpatient, continued inpatient stay, outpatient services and medical specialty pharmacy on the medical benefit.
For covered in-network services requiring authorization:
Ascension is waiving preauthorization requirements for dates of service beginning 5/8/2024 until further notice. If you previously submitted an authorization request and you have not yet received our decision, our UM Team will contact you by phone with the authorization decision.
Exceptions: Send authorization requests for the following services as indicated:
1. For Transplants, Cellular therapy, Gene Therapies, and out-of-network services:
- Dell Children's Health Plan: dchp-um@ascension.org
- SmartHealth (all plans) and Employer Groups (Levy, Trimedx, Cherokee): smarthealthum@ascension.org
- Ascension Personalized Care: shp-authorization@ascension.org
2. For ABA therapy, send authorization requests as follows:
- Dell Children's Health Plan: magellanhealth.com
- SmartHealth (all plans) and Employer Groups (Levy, Trimedx, Cherokee): smarthealthum@ascension.org
- Ascension Personalized Care: shp-authorization@ascension.org
3. DCHP members only: For physical therapy, occupational therapy and speech therapy send authorization requests as follows:
- Dell Children's Health Plan: dchp-um@ascension.org
For medical necessity appeals, please email the appeal to:
- Dell Children's Health Plan: dchp-um@ascension.org
- SmartHealth (all plans) and Employer Groups (Levy, Trimedx, Cherokee): smarthealthum@ascension.org
- Ascension Personalized Care: shp-authorization@ascension.org
Authorization is not a guarantee of payment. Services must meet all other plan requirements for coverage.
Medical Access Program (MAP) and Charity Program
For new authorization requests:
This message applies to in-network inpatient, continued inpatient stay, outpatient services.
For covered in-network services requiring authorization:
Ascension is waiving preauthorization requirements for dates of service beginning May 8, 2024, until further notice. If you previously submitted an authorization request and you have not yet received our decision, our UM Team will contact you by phone with the authorization decision.
Exceptions: Send authorization requests for the following services as indicated:
For MAP and Charity services requiring device donations
- Seton Health Plan: shp-authorization@ascension.org
For charity patients not enrolled in an assistance program (i.e. MAP Basic, CCHC and SetonCare Plus) - Home Care, Home Infusion Therapy and DME
- Seton Health Plan: shp-authorization@ascension.org
Authorization is not a guarantee of payment. Services must meet all other plan requirements for coverage.