Commercial Provider

If you’re a member of our Medicare Advantage network through the Monterey Bay Independent Physicians Association (MBIPA), click here for your resources.

Commercial Roster Information  – Update Form
English Form / Spanish Form

Commercial HMO Network Provider Manuals
Providers who care for members in one of our managed care commercial plans must abide by their provider manual requirements.

Please review the provider manuals of our health plan partners:
Anthem Blue Cross HMO
Blue Shield Trio HMO

Medical Policies and Clinical Utilization Management Guidelines
Providers who care for members in one of our managed care commercial plans must use these guidelines below as the first tier of the decision hierarchy.
Please review the clinical utilization management guidelines of our partner plans:
Anthem Blue Cross HMO
Blue Shield Trio HMO

Medical Authorizations
(831) 657-1600
(831) 657-2669 Fax
Authorization Request Form
Submit authorization requests electronically at:  id.phtech.com.

If you do not have a portal account and would like to establish one, please call (503) 584-2169

Health Care Coverage During a State of Emergency

Aspire Health, in coordination with its full-service commercial plan partners, must provide enrollees who have been displaced or whose health may otherwise be affected by a state of emergency, as declared by the Governor, or a health emergency, as declared by the State Public Health Officer, with access to medically necessary health care services. Learn more about Aspire Health’s commitment to Health Care Coverage During a State of Emergency. Should a declared state of emergency or health emergency arise, Aspire will activate its Disaster Relief Plan.

• Disaster Relief Plan
• Health Care Coverage During a State of Emergency

Utilization Management Policies and Procedures

Depending on the members you serve, you may need to obtain approval from Aspire Health before the patient undergoes a specific procedure and/or service.

Please review our policies and procedures:

• 2021-2022 UM Program DescriptionAHP ASO OP001 – Access to UM Staff and Communication Service
• AHP ASO OP002 – Timeliness of UM Decision and Notifications
• AHP ASO OP003 – Disclosure of UM Criteria and Polices
• AHP ASO OP004 – Emergency Services
• AHP ASO HS027 – Utilization Review Criteria
• AHP ASO HS053 – Language Assistance Program
• AHP ASO HS061 – Non-Delegated Transplant Services
• AHP ASO HS064 – Standing Specialist Referrals – Member with Life-Threatening, Degenerative, or Disabling Condition
• AHP ASO HS065 – Second Opinions
• AHP ASO HS066 – Cancellation/Withdrawal of Prior Authorization
• AHP ASO HS067 – Direct Access to OB/GYN
• AHP ASO HS069 – Coverage Denials for Members with Terminal Illnesses
• AHP HSO-HS070 – Standing Specialist Referrals – Members without Life-Threatening, Degenerative, or Disabling Conditions
• AHP HS018 – Availability of Criteria
• AHP HS071 – Rescinding Authorizations

Credentialing and Contracting
Provider Networks and Contracting Team
(831) 657-0700
For assistance, please email network_support@aspirehealthplan.org

Credentialing Policies and Procedures
Healthcare professionals who wish to join our managed care commercial HMO network will be subject to credentialing by Aspire Health. The Plan utilizes CAQH for submission of completed, signed and dated applications. Click here to for more information about CAQH.

Before you apply, please review our policies and procedures:

• AHP-PS001 Provider Network Credentialing Standards – CR1
• AHP-PS002 Provider Network Credentialing Committee – CR2
• AHP-PS003 Provider Network Credentialing – CR3
• AHP-PS004 Provider Network Recredentialing Cycle Length – CR4
• AHP-PS005 Provider Network Ongoing Monitoring and Interventions – CR5
• AHP-PS006 Provider Network Notification to Authorities and Practitioner Appeal Rights – CR 6

Claims Submission

Salinas, CA 93912

Provider Customer Service

* UM decision making is based only on appropriateness of care and service and existence of coverage. Aspire Health does not specifically reward practitioners or other individuals for issuing denials of coverage or care. Financial incentives for UM decision makers do not encourage decisions that result in underutilization.