Medicare Part D: The Medicare prescription drug benefit program. We call this program “Part D” for short. Medicare Part D covers outpatient prescription drugs, vaccines, and some supplies not covered by Medicare Part A or Medicare Part B or Medical Assistance. Our plan includes Medicare Part D.Medicare Part A: The Medicare program that covers most medically necessary hospital, skilled nursing facility, home health, and hospice care.
Medicare Part B: The Medicare program that covers services (such as lab tests, surgeries, and doctor visits) and supplies (such as wheelchairs and walkers) that are medically necessary to treat a disease or condition. Medicare Part B also covers many preventive and screening services.Medical Assistance: This is the name of Minnesota’s Medicaid program. Medical Assistance is run by the state and is paid for by the state and the federal government. It helps people with limited incomes and resources pay for long-term services and supports and medical costs.
It covers extra services and some drugs not covered by Medicare. Medicaid programs vary from state to state, but most health care costs are covered if you qualify for both Medicare and Medicaid.

Provider Portal and Authorizations

Provider Portal Login

CLICK THE LINK ABOVE TO ACCESS THE PORTAL

Use the Provider Portal for claim dates of service starting January 1, 2019. For dates of service prior to January 1, 2019, or any other issues or questions when using our Provider Portal, please call the Provider Contact Center at 1-888-633-4055.

South Country Provider Portal Accumulator Disclaimers

The South Country Health Alliance provider web portal currently displays vision, home care skilled nursing, hearing aid, breast pump, hospice election and chiropractic accumulators. Click the link below for more information.

Prior Authorization and Notification Requirements

Select and download a list to review criteria for the following:

Cosmetic, Medical Dental, Diagnostics, DME, EIDBI, Experimental, Genetic Testing, Gender Confirmation Surgery, Hearing, Home Care, Inpatient, Medical Pharmacy, Mental Health & Substance Use Disorders, Out-of-Network, Skilled Nursing Facilities, Surgery, Transplants, Transportation, Wound Care, Vision and Miscellaneous.

Previous Years' Lists

 

Last Updated on 04/01/2024 by Chris Gartner

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