Prior authorization
We update prior authorization requirements regularly to align with program or code changes. Please refer to our prior authorization requirements before delivering planned services:
- Prior authorization requirements, Jan. 1, 2026
- Prior authorization requirements, April 1, 2026
- Prior authorization requirements, July 1-July 31, 2026
- Prior authorization requirements, Aug. 1-Oct. 1, 2026
- Prior authorization requirements, Oct. 1, 2026
You can request prior authorization in multiple ways:
Through our self-service portal: Log in to Availity® Essentials to verify a member’s benefits, coverage and eligibility. After confirming, access the prior authorization portal through the HealthSpring Medicare Advantage payer space and submit all supporting documentation.
Or submit to us: Refer to our prior authorization forms. Complete the forms in their entirety and attach pertinent clinical information.
Mail to:
HealthSpring
Attn: Prior Authorization
500 Great Circle Road
Nashville, TN 37228
Call or fax:
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Contact
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Phone
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Fax
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|---|---|---|
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Behavioral health
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1-866-949-4846
|
|
Drugs or biologics Part B
|
|
1-877-730-3858
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|
CareAllies
|
|
1-866-233-6235
|
|
Clinical operations
|
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1-866-287-5834
|
Review how to submit prior authorization requests for direct admission to a postacute setting.
View Home Health Care Authorization Bundles.
Refer to our provider manual for more information.
Medicare Part B Step Therapy Program
Step therapy is a required process that applies to certain Part B prescription drugs. It requires members to first try a preferred medication over nonpreferred medications that treat the same condition.
See our information for providers on step therapy, including preferred medication lists:
- Step therapy information, effective April 1, 2026
- Step therapy information, effective July 1, 2026
- Step therapy information, effective Oct. 1, 2026
For medical non-oncology indications, or for delegated oncology reviews not managed by EviCore healthcare, refer to:
- The information above on how to make prior authorization requests
- Part B forms
For medical oncology indications, or EviCore-delegated reviews, providers may request prior authorization or step therapy reviews by:
- Accessing the prior authorization list on the EviCore resources page
- Submitting a request via the EviCore Providers’ Hub, or calling 1-866-686-4452 (encouraged for urgent treatment requests)
- For Part D drug list and Part D utilization management requirements, refer to the Part D Complete Medicare Drug List.
Prior authorization statistical data
We compile statistical information associated with all prior authorization requests received in the previous year.
Review our 2025 prior authorization report.