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 Roster Information

Call (831) 657-0700, email network_support@aspirehealthplan.org, or use the form linked below to report Anthem Blue Cross HMO or Blue Shield Trio HMO provider directory inaccuracies.

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:


Claims Submission

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

Claim Policies and Procedures
Aspire Health complies with all the claims payment requirements set forth in the Knox-Keene Health Care Service Plan Act of 1975. Aspire Health providers should review the policies and procedures regarding claims submission and processing, listed below, to ensure they are up-to-date on the current practices of the plan.

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:

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.

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

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

Non-Pharmacological Pain Management Treatment
Aspire Health has worked alongside its full-service commercial HMO plan partners to provide resources related to non-pharmacological therapies. Health & Safety Code § 124962 requires health plans and their contracted providers to encourage the use of evidence-based non-pharmacological therapies for pain management.

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.

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: