Information for Providers

Medical Services

Aspirus Health Plan has partnered with Magellan to manage the utilization and quality of its members’ outpatient and in-home rehabilitative and habilitative therapy services. You must register to access functionality that will help you with your Aspirus Health Plan Therapy Authorizations.

Direct all authorization questions to Magellan Healthcare:

Phone: 952-225-5700 or 1-888-660-4705 (toll free)
Fax: 1-888-656-1952

Medical necessity guidelines are available to assist in the determination of medical necessity for certain clinical procedures (procedure, therapy, diagnostic test, medical device, etc.) where coverage requires determination of medical necessity. 

Utilization Management Criteria Memo (PDF)

Pharmacy and Drug Coverage Info

Find drug coverage for each Aspirus Health Plan Medicare Advantage plan and information to request exceptions or authorizations on our Pharmacy page. A formulary outlining the covered drugs and associated limitations, along with criteria used for prior authorizations is available:

2021 Formulary   
2022 Formulary

Find medical injectable drug prior authorization information for Aspirus Health Plan Medicare Advantage plans and forms to request authorizations on our Pharmacy page.

Care Management Referrals

The Care Management Referral form is completed when you have a member/patient who you feel would benefit from care coordination services and is actively enrolled in an Aspirus Health Plan Medicare Advantage Plan.

Care Management Referral Form (PDF)

Disease Management Program & Referrals

The Disease Management Referral form is completed when you have a member/patient who you feel would benefit from these services and is actively enrolled in an Aspirus Health Plan Medicare Advantage Plan.

Disease Management Programs (PDF)
Disease Management Referral Form (PDF)

Delegates






Aspirus Health Plan works with delegated organizations to handle the following types of authorization.

Direct all authorization questions to Aspirus Health Plan’s delegate, Fulcrum Health, Inc. | 1-877-886-4941 (toll free)

Direct all authorization questions to Aspirus Health Plan’s delegate, Delta Dental 1-866-298-5520 (toll free) or 612-402-3950

Direct all authorization requests to Aspirus Health Plan’s delegate: Care Continuum, a subsidiary of Express Scripts Online (ePA) at www.express-path.com  Phone: 1-866-540-8289 (toll free) | Fax: 1-866-540-8935. 

Direct all authorization requests to Aspirus Health Plan’s delegate, Express Scripts, 1-877-558-7521 or by fax at 1-877-251-5896. Find more information on our Pharmacy page.

Direct all authorization questions to Aspirus Health Plan’s delegate, Magellan Healthcare, Inc. | 952-225-5700, 1-888-660-4705 (toll free)| Fax:
1-888-656-1952