As a PCP, do I need authorization from Peoples Health to perform laboratory services in my office?
All lab work must be sent to our network labs for testing except for certain procedures that you are authorized to perform in your office. For a listing of procedures that you can perform in your office, please refer to the Peoples Health Provider Reference Guide or the Physician Quick Reference Guide. Contact your Peoples Health representative if you need more information about performing laboratory services in your office.
Do I need to have services authorized before I perform them?
Certain services and procedures require prior authorization before they can be rendered, and these are listed on the back of the Medical Necessity Form. If you determine that your patient needs one of these services or procedures, you must request prior authorization from Peoples Health to ensure those services will be covered.
There are some exceptions to the listing on the form, which can be determined by using the Authorization Requirements Search. You can search the database by selecting a place of service code and inputting a CPT code to determine if the procedure requires prior authorization.
Medical Necessity Form
Download Medical Necessity Form – PDF
To request authorization for oral chemotherapy drugs, submit a request to our pharmacy benefit manager, OptumRx.
To request authorization for injectable chemotherapy, cancer-supportive drugs and therapeutic radiopharmaceuticals, submit a request to the Optum® Cancer Guidance Program through its MBMNow platform.
- Log in to Provider Portal and click the Authorizations.
- Click the Cancer Treatment icon to be redirected to the MBMNow website.*
To request authorization for all other services requiring authorization, submit a request online by logging in to Provider Portal and clicking the Authorizations tab. If you do not have the ability to submit a request online, complete a Medical Necessity Form and fax it to us.
- For oral chemotherapy authorization requests: Using the OptumRx link above, create or sign in to your CoverMyMeds account.
- For injectable chemotherapy, cancer-supportive drug and therapeutic radiopharmaceutical authorization requests: Visit https://mbm.linkplatform.com/home to log in or register for an MBMNow account.
- For authorization requests for all other services: Contact us to register for a Peoples Health Provider Portal account.
*If you already have an MBMNow account for another health plan, it will work for Peoples Health patients, as long as you are accessing the MBMNow website from the link located within your People Health Provider Portal account, as described above; on the MBMNow website, click Sign in and select the One Healthcare ID icon to login. If you do not already have an MBMNow account, you can create one through the self-registration link on the MBMNow website, as accessed through the link within your People Health Provider Portal account.
How do I verify member eligibility and information?
Use Provider Portal to verify member eligibility. If you are a network provider and need access to the portal, click here to proceed to our sign-up process.
You can send a request to confirm eligibility and information directly from our website or you can call us toll-free at 504-849-4690, 225-346-5705 or toll-free at 1-866-553-5705, Monday through Friday, from 7 a.m. to 4:30 p.m.
What if I have questions about my Explanation of Payment (EOP)?
Please contact us to request an explanation of your EOP.
What if I need forms and/or other documents?
If you need additional forms or other documents, you can either download them from the Provider Plan Documents and Forms page or you can call your Peoples Health representative to receive printed copies.
What lab facility should I use?
You must use network lab providers for all laboratory services, unless it is otherwise noted in your Provider Reference Guide that you can perform the laboratory service in your office or at your facility. Please refer all Peoples Health plan members to Quest Diagnostics or the nearest network lab provider in your area. Use the Other Provider Search tool to find a listing of network lab providers in your area.
What if I can't get in touch with my Peoples Health representative?
If you cannot reach your Peoples Health representative, contact us at firstname.lastname@example.org.
How do I know which physician team the member is in?
To find out which physician team the member is in, you can call us at 504-849-4690, 225-346-5705 or toll-free 1-800-553-5705, Monday through Friday, from 7 a.m. to 4:30 p.m.
What do I do in the event of an emergency?
A disaster can damage your ability to conduct your practice. Peoples Health requests that you complete our Evacuation Communication Information form to help ensure that we can maintain contact with you in the event of an emergency. You can download the form below and return it via fax to your Peoples Health representative at 504-849-6916.
Evacuation Communication Information Form
Download Evacuation Communication Information Form – PDF
As an out-of-network provider, can I treat Peoples Health patients?
Most 2023 Peoples Health plans require that plan members receive most care from network providers, except in certain situations, such as emergency or urgent
situations or for dental services; however, the following plans do offer an out-of-network benefit that allows enrolled members to receive other services from out-of-network providers. Members may pay higher costs for out-of-network services.
Peoples Health Group Medicare (HMO-POS)
Peoples Health Group Medicare (HMO-POS) Office of Group Benefits
For services requiring authorization, you must obtain prior authorization from Peoples Health before rendering the service. Complete a Medical Necessity Form, and fax the form and any supporting documentation to one of the numbers on the form.
To verify patient eligibility, contact the provider services department at 1-877-346-5703, Monday through Friday, from 8 a.m. to 5 p.m. You will need to provide the plan name and member ID number, which you can find on the front of the patient’s Peoples Health ID card.
For more information, visit Information for Out of Network Providers.
Can out-of-network providers enroll in electronic funds transfer (EFT)?
Yes, out-of-network providers can enroll in EFT. Note that you must also receive electronic remittance advice (ERA) to enroll.
Sign up for ERA – search for payer ID 72126
How do you make coverage decisions?
Be assured that Peoples Health makes decisions about coverage for health care services as such:
- Utilization management decision-making is based only on medical necessity, appropriateness of care and services, and existence of coverage.
- Peoples Health does not reward practitioners or other individuals for issuing denials of coverage.
- Financial incentives for utilization management decision-makers do not encourage decisions that result in underutilization.
As a reminder, services requiring prior authorization are screened against medical necessity criteria, Medicare guidelines and/or Peoples Health policy. Procedures that do not require initial medical necessity review must still meet medical necessity criteria, Medicare guidelines and/or Peoples health policy, and are subject to retrospective review. To request medical necessity criteria for a specific procedure, contact our medical management department at 1-866-553-5705.