Resources

Here is where you can find information to become more familiar with HealthHelp, including our case studies, white papers, clinical guidelines, and more.

Resources

 

Here is where you can find information to become more familiar with HealthHelp, including our case studies, white papers, clinical guidelines, and more.

Case Studies & White Papers

Clinical Guidelines

To locate the appropriate HealthHelp Clinical Guideline, you can search our library by keyword, service type OR procedure code.

The purpose of these clinical guidelines is to assist healthcare professionals in selecting the medical service that may be appropriate and supported by evidence to improve patient outcomes. These clinical guidelines neither preempt clinical judgment of trained professionals nor advise anyone on how to practice medicine. The healthcare professionals are responsible for all clinical decisions based on their assessment. These clinical guidelines do not provide authorization, certification, explanation of benefits, or guarantee of payment, nor do they substitute for, or constitute, medical advice.

Federal and State law, as well as member benefit contract language, including definitions and specific contract provisions/exclusions, take precedence over clinical guidelines and must be considered first when determining eligibility for coverage. All final determinations on coverage and payment are the responsibility of the health plan. Nothing contained within this document can be interpreted to mean otherwise.

Medical information is constantly evolving, and HealthHelp reserves the right to review and update these clinical guidelines periodically.

Cardiology Services

Cardiology Services

Diagnostic Imaging: Cancer Indications

Diagnostic Imaging: Cancer Indications

Diagnostic Imaging: Non-Cancer Indications

Diagnostic Imaging: Non-Cancer Indications

Medical Oncology

Medical Oncology

Musculoskeletal Surgical Services

Musculoskeletal Surgical Services

Radiation Therapy

Radiation Therapy

Sleep Studies

Sleep Studies

Surgical Services

Surgical Services

Forms

Texas Standardized Prior Authorization Request Form For Health Care Services

Texas Form Instructions Texas Request Form

Indiana Standardized Prior Authorization Request Form For Health Care Services

Indiana Request Form
 

WNS-HealthHelp Frequently Asked Questions

You can reach us at (800) 405-4817 for general information about our services, Monday through Friday, 8AM-6PM. To contact a HealthHelp sales representative, call (877) 795-0373. After business hours, call (800) 405-4817 and leave a message and phone number and we will return your call the next business day.

Registered users may initiate a request using the red log-in button at the top of this page or contact Program Support at 800-546-7092 to set up a new account. During business hours, you can also call HealthHelp at (800) 405-4817.

You can call (800) 405-4817 during business hours.

The best way to expedite the review process is to provide complete information from the outset, such as:

  • Member Demographics (Name, DOB, Health Plan Name, ID#)
  • Ordering Provider Demographics (Name, Location, or Tax ID#)
  • Servicing Provider Demographics (Name, Location, or Tax ID#)
  • Service Requested
  • Diagnosis
  • Additional clinical information, such as duration of symptoms, prior test results, prior applicable personal and/or family medical history, or prior treatment type and duration.

One way is to verify that the member’s health plan participates with HealthHelp. You can check a member’s eligibility by calling us at (800) 405-4817 during business hours.

Our most current clinical guidelines are available above. A request for a copy of criteria can also be made by calling (877) 685-5264 during business hours.

Services may vary based on the individual health plan. Each health plan should provide a list of CPT codes and a description of the utilization review process. If you cannot find the answers you need, call us at (800) 405-4817 during business hours.

We are always looking to optimize and improve our services and appreciate your feedback. Please call (800) 405-4817 during business hours.