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
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
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.