Health Partners Plans/Jefferson Health Plans
Effective Jan. 1, 2026, Magellan will no longer manage the behavioral health services for Health Partners Plans/Jefferson Health Plans members.
To continue as an in-network provider serving these members on and after Jan. 1, 2026, you’ll need to follow Health Partners/Jefferson Health Plans' processes to become a contracted provider. Visit Optum Provider Express for information on joining the behavioral health network.
For dates of service through Dec. 31, 2025, continue with current processes via Magellan. For dates of service on and after Jan. 1, 2026, verify eligibility and benefits, obtain prior authorization, and submit claims following Health Partners Plans/Jefferson Health Plans' processes.
We’ll publish further details and resources as they become available.
Quick Reference Guide
- Quick Reference Guide (PDF)
Model of Care Training
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Take the Health Partners Plans Model of Care Training for Care Management Providers.
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Complete the Attestation for Model of Care Training.
Pennsylvania Prior Authorization Process for Commercial and CHIP Plans
Medical Necessity Criteria/Medical Policy
Substance use disorder:
- American Society of Addiction Medicine (ASAM) and An Introduction to The ASAM Criteria for Patients and Families (PDF) - Licensee's use and interpretation of the American Society of Addiction Medicine’s ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits.
Applied behavior analysis and psychological testing:
Other mental health services:
- Additional criteria are available here.
Prior Authorization Requirements
- Preauthorization requirements for Health Partners Plan / Jefferson Health Plan CHIP and Exchange (PDF)
Requesting Prior Authorization
Some facility and non-routine outpatient services may be requested online via the Request Member Care application.
- Sign into this website and select Request Member Care from the left-hand menu.
- If the provider portal (Request Member Care app) is not available, you may contact Magellan at 1-800-424-3702 for Health Partners CHIP members and 1-800-424-3706 for Health Partners/Jefferson Health Plan Exchange members for authorization.
Tutorials:
User guides:
- Request Member Care – Facility services (PDF)
- Request Member Care – Non-routine outpatient services (PDF)
For services that require prior authorization and are not accessible through the Request Member Care application, complete the appropriate form below and fax it to Magellan.
- For autism-related forms, sign in to this website. From the Resources section, select State & Plan Information, then choose Autism-Specific Information to access:
- ABA Initial Authorization
- ABA Treatment Plan/Concurrent Review
- Psychological Testing Preauthorization Request Form (PDF)
- ECT Authorization Request Form (PDF)
- TMS Authorization Request Form - initial and concurrent (PDF - print for handwritten completion)
- TMS Authorization Request Form - initial and concurrent (Word - download for digital completion)
- Fax number for completed form submissions:
- ABA: 1-888-656-4925
- Psychological testing and ECT: 1-888-656-0259
- TMS: 1-888-656-4967
- Customer service numbers:
- Health Partners CHIP: 1-800-424-3702
- Health Partners/Jefferson Health Plan Exchange: 1-800-424-3706
- Provider Services Line: Chat with us or contact us at 1-800-788-4005 for technical issues with the website.
Requesting a Peer-to-Peer Consultation
To request a peer-to-peer consultation, contact Magellan’s Utilization Management Support Team at 1-800-741-2304, option 3, then Option 2.
- Peer-to-peer process (PDF)
CHIP Enrollment
- CHIP providers: Enroll with PA DHS to remain eligible for payment/network participation (PDF)
- Children's Health Insurance Program (CHIP) Handbook (PDF)