Commercial Provider

decrorative decrorative decrorative

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

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

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:

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:

Claims Submission

Salinas, CA 93912

Anthem Blue Cross HMO
Blue Shield Trio HMO
Coastal TPA Employer Groups
Coastal TPA
Po Box 80308
Salinas, CA 93912
Coastal TPA
Po Box 80308
Salinas, CA 93912
Smart Data Solutions
Payor ID 77052
Smart Data Solutions
Payor ID 77052

 

Provider Customer Service

Anthem Blue Cross HMO
Blue Shield Trio HMO
Coastal TPA Employer Groups
(831) 754-3800
Toll Free: (800) 564-7475
coastalmgmt.com
info@coastalmgmt.com
(831) 754-3800
Toll Free: (800) 564-7475
coastalmgmt.com
info@coastalmgmt.com

* 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.