Our mission is to take the administrative burden off of your plate, so you can spend more time focusing on what’s important, your patients.
You will be able to find valuable resources here or on your provider portal.
Access Your Provider Portal
Our online Provider Manual hosts the most up-to-date information on eternalHealth’s
products, programs, policies, and procedures.
Jump to what you are looking for:
Quick Reference Guide
Quick links, phone numbers,
and information you need.
Member Eligibility & Covered Benefits
Identification & eligibility of
members, service areas,
referrals, covered benefits,
coordination of benefits, and
Standards of participation, standards, member referrals, access to medical records, non-adherent members, provider collection data, compliance.
Claims & Billing
Claim submission information and program integrity.
Payment dispute information.
Fraud, Waste, & Abuse
State and federal laws, and
eternalHealth policies and
Circumstance for termination,
non-renewal of contract, and
continuity of care
Provider and Pharmacy Directory
Online look-up tools
Find a provider or specialist and look up a pharmacy closest to you!
Available for download
The following documents may not contain the most up to date information. Please utilize the on-line look-up tools to search our directories in real time.
File a Request on Behalf of Your Patient.
If your patient needs to see a specialist, fill out this form!
Request for Medicare Prescription Drug Coverage Determination
This form will help your patient determine their coverage of a prescription drug.
Request For Redetermination Of Medicare Prescription Drug Denial
Your patient may appeal a coverage determination about a prescription drug with this form.
Request for Redetermination of Medical Services and Products
Your patient may appeal a coverage determination about medical services or products with this form.
Medicare Advantage Prior Authorization List
This is a list of products and services that require prior authorization before they are provided/administered.
Medicare Advantage Part B Prior Authorization List
This is a list of medications that require prior authorization before they are provided/administered.
Provider Portal Enrollment
If you are looking to get access to the provider portal, please fill out this form and your credentials will be emailed to you.
Provider Portal Fact Sheet
Please use this as a reference, as it shows you the functionality available on the provider portal.
Provider Quick References
This document will give you a high-level summary of the eternalHealth Provider Manual!
Can’t Find What You Are Looking For?
Our team is available and happy to help.