Health New England Specialty Partner Contacts 

As a health plan committed to finding ways to keep health care costs down, we partner with specialists with deep expertise in their fields to manage some of our programs. These specialty partners help us in many ways, including authorization management, prescription drug savings, specialty pharmaceutical solutions, chiropractic services, and behavioral health.

Our partners are available to work directly with our providers whether for a prior approval request or an inquiry.

Prior Approval Process

Providers should contact Health New England’s specialty partners directly (contact information below) for prior approval requests for the following services:

  • Chiropractic services
  • Durable medical equipment (DME)
  • Medicaid behavioral health services 
  • Non-emergency medical transportation 
  • Outpatient imaging services, genetic testing and sleep studies (and related sleep DME) 
  • Pharmacy services and specialty medications

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Contact Information

Chiropractic Services

Optum
Optum manages chiropractic services for Commercial, Medicaid and Medicare plans.
(888) 676-7768
Provider Locator: myoptumhealthphysicalhealth.com/providerlocator.asp

Chronic Kidney Disease and Kidney Health Management

Healthmap Solutions
Phone: (800) 481-0474
healthmapsolutions.com

Durable Medical Equipment

Northwood
Northwood manages DME for Commercial, Medicaid and Medicare plans.
northwoodinc.com/health-new-england-inc

  • Online Provider Portal – Participating providers must submit authorization requests online at https://providerportal.northwoodinc.com. Please contact Northwood to obtain a login ID and password.
  • Fax – Non-participating providers may submit a completed Prior Authorization Fax Form to Northwood at (877) 552-6551. If sent after-hours or on weekends, Northwood will respond on the next regularly scheduled business day. 
  • Phone – For urgent/emergent requests only, providers may call Northwood on the dedicated Health New England provider line at (877) 807-3701 during normal business hours (8:30 a.m. to 5:00 p.m. EST, Monday through Friday), or within two (2) business days when services were provided after-hours.

High Cost Claims Review

Zelis Claims Integrity, Inc
2 Crossroads Drive
Bedminster, NJ 07921
Attn: Provider Services
Phone: (855) 250-3338
Email: providerservices.integrity@zelis.com

Inpatient Claim Review

Amenity
7001 St. Andrews Road # 348
Columbia, SC 29212
Phone: (888) 928-7479 / Fax (877) 827-2209
Email: providerrelations@amenityconsulting.com

Medicaid Behavioral Health Services

Massachusetts Behavioral Health Partnership (MBHP)
MBHP manages all behavioral health services for BeHealthy Partnership/Medicaid plan.*
(800) 495-0086
Hours: 24/7

*MBHP, in partnership with Beacon, also manages behavioral health services for a population of our adolescent Commercial members.

Medicare Advantage End Stage Renal

Discovery Health Partners
Phone: (800) 573-5904
Email: esrd@discoveryhealthpartners.com

Non-Emergency Medical Transportation

American Medical Response (AMR)
AMR manages non-emergency transportation for Commercial, Medicaid and Medicare plans.
amr.net

Springfield area:
Phone: (413) 846-6100
Dispatch: (413) 736-0600
Email: amr.springfield@amr.net

Hartford, CT area:
Phone: (860) 241-2417
Dispatch: (800) 660-1077
Email: amr.hartford@amr.net

Outpatient Imaging Services, Genetic Testing and Sleep Studies

eviCore (formerly MedSolutions)
eviCore manages select outpatient imaging services, sleep studies and genetic testing for Commercial, Medicaid and Medicare plans.
(888) 693-3211
Monday – Friday, 7:00 a.m. – 7:00 p.m.

eviCore manages ALL outpatient:
  • CT scans 
  • Virtual colonoscopy 
  • MRI; PET Scans 
  • Nuclear cardiology 
  • All diagnostic sleep tests, PAP therapy devices, and PAP therapy DME supplies 


    • Prior Authorization
    To obtain a prior authorization, or to access commonly used managed codes for Genetic Lab, Sleep Study Program or High Cost Imaging, log on to the eviCore portal. A username and password is required. When checking on a status or denial of an authorization, you may call eviCore at (888) 693-3211.

Pharmacy Services

OptumRx
OptumRx is the pharmacy benefits manager (PBM) for all Commercial, Medicare and Medicaid plans.
(800) 918-7545 (for physician use only)
Fax: (800) 550-9246 (for physician use only)

Optum Specialty Pharmacy (formerly BriovaRx)
Optum Specialty Pharmacy is the preferred specialty pharmacy for specialty medications, injectables and other self-administered treatments for Commercial, Medicare and Medicaid plans.
(877) 633-4807
Fax: (877) 292-5799 (for physician use only)
Patient care coordinator available 24/7

Magellan Rx
Magellan Rx manages therapeutic medications for Commercial, Medicaid and Medicare plans.
(800) 424-8325
Monday – Friday, 8:00 a.m. – 6:00 p.m.

Sample of therapeutic drug classes that Magellan Rx manages:
  • Oncology
  • Osteoporosis
  • Anti-emetic
  • Immunodeficiency
  • Inflammatory conditions
  • IVIG
HNE