Thank you for being a Health Partners Plans (HPP) participating provider.

We are providing updates to prior authorization requirements since our last communication dated January 27, 2022 (PC-420-NM-2022-0012 – COVID-19 Authorization Process Changes). The following requirements apply to all lines of business managed by HPP and went into effect on June 15, 2022.

• Retrospective review for medical necessity will be reinstated for:
  • In-Patient Skilled Nursing Facility
  • Non-Elective Admissions
  • Acute Rehabilitation Facility

For those cases not already reviewed for medical necessity during the waiver period of December 2021 through March 2022, we reserved the right to conduct retrospective reviews. As such, medical records will be requested for specific cases in order for the retrospective review to be conducted. The outcome of those reviews will be communicated to you.

We will continue to keep you informed of any additional changes, including those required by our regulators.

HPP encourages providers to visit our COVID-19 Resources for Providers webpage at HPPlans.com/COVID for additional information.

Thank you for your support in providing care to our members.