• Provider Notice - February 2018

  • On March 1, 2018, Affinity Intake will begin using a new Prior Authorization Form for our products. We also are requiring that all necessary clinical information be attached to this form in order for Affinity to build on or start the authorization process. Because we are requesting all clinicals, we no longer will accept initial authorization requests via the Intake phone line after March 1. All authorization requests must be faxed to 718.794.7822. Any requests missing required information may be returned without approval. This procedure is only for those requests going to Affinity and does not affect current Beacon or Evicore processes.

    Please use the improved web tools found on our Provider Portal to:

    • Determine which services require an authorization
    • Check to see if an authorization has been approved or pending

    Also effective March 1, providers will need to visit our website in order to determine if a service requires an authorization, as well as to report the status of a requested authorization.

    Our new and improved website contains information outlining how to use the tools. Our Provider Relations representatives are available to assist you with any questions or issues accessing the site.

    Please call the Intake Department if you have any questions about the Prior Authorization Form or about the information that needs to be included with the Authorization request.

    Inpatient Authorized Days

    As a reminder, Affinity is approving inpatient admissions and lengths of stay based upon information presented at the time of the admission. When the approval is given, Affinity will notify you of the approved length of stay. Once the approved days have expired, it is the responsibility of each provider to call back with additional clinicals if additional days are necessary. In addition, any clinicals requested by Affinity are due within 72 business hours of the request. ; Should clinicals be late, it is possible to have days denied in the middle of a stay.

    Clinical Practice Guidelines

    Over the next few weeks, Affinity will be distributing new clinical practice guidelines. We will notify you via fax when these guidelines are available, and will post them on the provider portal. Please visit the Portal often to ensure that you are up to date on any new changes.

    Portal Update

    Remember, providers are now able to access the portal to check authorization statuses, to determine if a procedure requires an authorization.

    Affinity Health Plan thanks you for your continued support and partnership!

  • Pharmacy Grievances

  • A grievance is a complaint about any problem you had with Affinity or one of our network pharmacies. Grievances do not relate to payment for or approval of a prescription drug, which are known as coverage determinations.

    Contact Us Immediately

    If you (your appointed representative) have a grievance, please:

    • Call Customer Service:
      866.362.4002
      TTY: 711
    • Fax: 866.633.7673
    • Mail:
      CVS Caremark Inc
      Part D Services
      MC109
      P.O. Box 52000
      Phoenix, AZ 85072-2000

    Expedited Grievances

    If you are grieving the decision by Affinity not to expedite an initial determination or an appeal, you can request an expedited grievance. In these situations, Affinity will respond to you within 24 hours.