For Providers / Tools
2027 Tools
- 2027 Prior Authorization List (PPO)
- 2027 Prior Authorization List (HMO)
- 2027 Prior Authorization Criteria
- 2027 Step Therapy Criteria
- 2027 Provider Manual
- 2027 HealthTeam Advantage Plan Contacts
- 2027 Provider Portal User Guide
- 2027 Provider Portal Azure User Login Guide
- Prior Authorization Request Form
- Home Health Prior Authorization Form
- Durable Medical Equipment Prior Authorization Request Form
- Acute, SNF, LTACH, IRF Authorization Request
- Additional Information Form
- Non-Emergent Ambulance Transport Request Form
- Part B Drug Prior Authorization Request Form
2026 Tools
- 2026 Prior Authorization List (PPO)
- 2026 Prior Authorization List (HMO C-SNP)
- 2026 Prior Authorization Criteria
- 2026 Step Therapy Criteria
- 2026 Provider Manual
- 2026 HealthTeam Advantage Plan Contacts
- 2026 Provider Portal User Guide
- 2026 Provider Portal Azure User Login Guide
- Prior Authorization Request Form
- Home Health Prior Authorization Form
- Durable Medical Equipment Prior Authorization Request Form
- Acute, SNF, LTACH, IRF Authorization Request
- Additional Information Form
- Non-Emergent Ambulance Transport Request Form
- Part B Drug Prior Authorization Request Form
Medication Look Up
Medical Policies and Medicare Coverage Database
In the absence of an applicable National Coverage Determination (NCD), Local Coverage Determination (LDC), or other applicable Medicare guidelines, HealthTeam Advantage may develop and apply internal coverage criteria. To search the Medicare Coverage Database or review our internal health plan policies, please visit the links below.
- Medicare Coverage Database: https://www.cms.gov/medicare-coverage-database/search.aspx
- Policy 9.13 CNC-NC Retrospective Authorization Request Policy
- Policy 9.20 CNC-NC Home Health Infusion Policy
- Policy 9.70 CNC-NC Visual Field Assessment
- Policy 9.90 CNC-NC Spinal Cord Stimulator Battery Replacement Therapy
- Policy 10.0 CNC-NC Tibial Nerve Stimulation for Bladder and Bowel Control
- HealthTeam Advantage Readmission Policy