Medical Management

Physician Health Partners performs medical management functions for the health plans contracted with PHP. The Medical Management department is responsible for precertifying referrals for all services that require prior authorization. PHP utilizes internally developed criteria along with Milliman Care guideliness to determine if a service is medically appropriate. All guidelines utilized by PHP are reviewed and approved by a committee comprised of area physicians and Physician Health Partners Medical Directors.

Precertification requests can be submitted online through MCS, an internet-based secure application available to participating providers to expedite the authorization process.