(Requires Prior Authorization for all members)
Participating physicians help ensure the affordability and success of members’ healthcare by referring them to participating specialists, hospitals, and ancillary providers. When participating physicians determine that the appropriate services are not available within MHP’s network, they are obligated to contact MHP’s Prior Authorization Department for assistance with accessing services.
When alternatives are available within the network, MHP will provide the necessary information for the physician’s office. When alternatives are not available, the Prior Authorization staff will assist the physician in arranging out-of-network care. When this approval is arranged in advance for non-emergent services, the member is eligible to receive the standard benefit. Non-emergent services conducted outside of the network, which are not pre-arranged through the Prior Authorization Department, would not qualify for coverage/payment unless the member has Point of Service benefits.
Please call the MHP Prior Authorization Department at 314-214-8282 or 800-647-2240 to initiate the evaluation process, or you may send a letter of medical necessity to the Prior Authorization Department. The chief medical officer, associate medical director, or a physician advisor reviews all requests for non-participating providers.